DAWOOD: Unique proposal on X-ray request form after spleen surgery

In the good old days, when there were no super-specialists and the general surgeon was really general in every sense — and had to operate on the human body from top to the toe — I did a lot of children’s surgery. I did it not because I wanted to “rush in where angels fear to tread” but because after obtaining my FRCS, I had done a year in a paediatric surgical unit.

It was a job divided between the world renowned hospital in London, known as the Great Ormond Street Hospital and its suburban branch, The Queen Mary’s Hospital for Children in Carshalton, Surrey. In the former, I was very lucky to work under Denis Browne, the doyen of paediatric surgery in the Commonwealth.

When I started working in Nairobi in 1961, there were no specialised paediatric surgeons in Kenya and I had ample opportunity to put my experience and skill to good use. When Intensive Care Units (ICU) – were introduced in the late seventies, they were tuned to the needs of adult patients only and ICU for children came much later. Since my “totos” needed specialised care after major surgery, I had to depend a lot on Sister in Charge of the children’s ward, to organise ICU like nursing care for them.

I remember her clearly; her first name was Millie. She was from Jamaica and had a long, complicated Jamaican surname, so she was called Sister Millie. In the interest of my tiny patients, I constantly endeavoured to keep her in good books. There was another reason for our close relationship. She was courting a Kenyan doctor, who happened to be my intern.

In spite of Millie throwing broad hints for Aggrey to pop the question, the young man was determined to sow many wild oats before settling down. When he drove Millie to exasperation, she needed a shoulder to cry on and I happened to be around to act as her “Agony Aunt.” She was also hoping that I would put in a good word for her, laced with authority! In comforting her, my usual spill was:

“Gone are the days when girls waited for suitors to go on their bended knees and pop the question. With the advent of Women’s Lib, women often take an initiative.”

“I am not that forward,” Millie replied.

“In that case,” I suggested. “You have to wait till the leap year. When I was in England,” I went on, “I learnt that on the 29th of February, which comes every four years, the shoe is on the other foot and a girl is allowed to propose to a boy. As far as I know, this special custom is prevalent all over the world.” Looking at the calendar, I added.” The next year is a leap year and you won’t wait too long.”

“I am afraid that an eligible boy like Aggrey will be swamped with overtures and I want to bag him before that,” Millie was quite candid.
But before the next 29th of February arrived, something happened, which precipitated the matter of Aggrey and Millie. It was one evening when I managed to come home early at about 7pm, my usual time being nearer nine or ten and I therefore planned a quiet dinner with Marie at home.

The social life in Nairobi and my professional life in the hospital were both hectic, so a dinner at home was a rare treat. I felt like the diplomat, who in his farewell speech on reaching the mandatory retirement age said “What I am looking forward to, is a quiet drink and dinner at home in my pyjamas and bedroom slippers.”

He then went on to explain the life he led as an ambassador of his country, accredited to Kenya. “Life involves a drive to the embassy five days a week, pore over State papers the whole morning, break for lunch at about midday, a game of golf in the afternoon, ending the day with a string of sundowners and dinners.” He then concluded.

”It would be nice to break this daily vicious cycle!”

Anyway our plans did not materialise. We had just finished our pre-dinner drinks and I had finished telling Marie the happenings of the day when my pager came to life; there were no mobiles then and I was instructed to rush to the children’s ward. I had operated on a newborn baby that morning, born with an abnormal connection between her windpipe and her food-pipe.

The milk from her mother’s breast was going from her oesophagus into her trachea choking her and subjecting her to a double jeopardy; she could not be fed and the milk going in her trachea was seeping into her lungs and likely to result in fulminating pneumonia. I had to open her chest and close the abnormal passage, a very major operation for a baby, a few hours old. I thought that the neonate had shot up a post-operative complication. I drove to the hospital at break-neck speed because the newborns can change their clinical condition quite quickly, at the least provocation. Nairobi traffic was not as crazy as it is now and at that time of the night, the roads were clear. On arrival, I went straight to the children’s ward, where the night nurse had message for me. “Sister Millie is waiting for you in the ICU,” she said.

“How is my toto, I operated this morning?” I asked.

“Sound asleep., she replied escorting me to the neonate’s cot. I found the tiny tot snoring gently, with a drip running in her vein and a tube in her chest, connected to a under-water seal drainage to expel the air and let the lung expand.

I ran to the ICU where I found Millie beside herself. As I approached her she rushed in my arms and moaned. “It’s my Aggrey.”

“What happened?” I asked.

“We had a romantic meal at the Kentmere Club on the Limuru Road and as we were returning to Nairobi, we were struck by a lorry on a steep hill.” Looking at herself, she added, “I came out with a few abrasions and bruises but Aggrey was badly injured. I stopped a passing car and requested the driver to bring us here. The doctor on duty diagnosed him as bleeding inside his abdomen and the ultra-sound has confirmed it and showed the ruptured spleen as the cause.”

I thought that she had finished giving me the medical history but she continued.” The doctor asked me if he should page the surgeon on call but I requested him to send Aggrey to ICU and I would deal with the rest. I told the operator to page you but in my panic forgot to tell him where I was. I wanted to give you the details on the phone but by the time the operator got your number, you had left and I talked to Marie.”

I rushed in the ICU, talked to the doctor, examined Aggrey and saw the ultra-sound. I agreed with the diagnosis, took Aggrey to the operating theatre, removed his severely fragmented spleen, sucked his peritoneal cavity of all the blood and closed it. It was midnight by the time we finished and the hospital kitchen sent us cheese and tomato sandwiches. As I munched them, while writing my operation notes, I mused – From a King to a Jack, considering the feast, Marie had planned at home. On reaching home, I found Marie waiting and the table laid on as I had left it!

After a restless night, I went to the hospital after a cup of tea and found Aggrey having his eggs and bacon breakfast and Millie beside him. They were chatting.

“I have taken a week’s leave,” she said to me.

Aggrey gave us a couple of anxious days but went home hale and hearty by the time Millie’s leave came to an end. In the meantime the leap-year with its 29th of February had come and gone.

Three months later, Millie and Aggrey came to see me, holding an invitation card to their wedding. “Ah, so my leap year idea worked!” I exclaimed in a gush of emotion, not realising that it wouldn’t be taken kindly by Millie.

“It happened before the 29th and it was Aggrey who proposed.” That was Millie’s sharp rejoinder.

“Let me put you fully in the picture,” Aggrey came to my aid.

“In the first three days after surgery, as I was drifting in and out of life, I decided that I couldn’t die without declaring my love to Millie, so I asked her to give me paper and kalamu.”

“I had no idea why he wanted the paper,” Millie emerged out of her umbrage.

“May be, to write a will or something. So I went to the Sister’s table and picked up an X-ray request form, the reverse of which you know is blank. He scribbled something on it and handed it back to me. I read it and found it was addressed to me. I quickly replied and gave it back.” Looking at the invitation card, she added. “This is the result of it.”

Aggrey put his hand in his pocket and brought out the vital document. On one side was the blank X-ray request form. I turned the page and written on the top in Aggreys hand was a statement and a question.

'I love you Millie. Will you marry me?” In the bottom of the paper was Millie’s reply. “You bet, I will!”