How ‘Surgeon’s Diary’ started at a Rotary weekly lunch meeting

This column is about how and why the ‘Surgeon’s Diary’ started. It happened at a Rotary lunch meeting at the New Stanley Hotel, where my Rotary Club of Nairobi met every Thursday in 1980.

 I had introduced a new member, and he had just been inducted. He was supposed to give ‘My Job’ talk to the Club.

The purpose of the talk was twofold — to give a detailed account of what a new Rotarian did for a living and ease his integration in the Club as well as mix with formidable members like Sir Ernest Vasey, Eric Cecil, popularly known as Bwana Safari, Mervyn Cowie, the man responsible for opening game parks in Kenya, Sir Derek Erskine, one of the few mzungus, who helped fight for uhuru and finally Sir Charles Mortimer, an ex-minister in the colonial government.

Unfortunately, the Rotarian developed a surgical emergency the previous evening and needed an urgent operation by me. Like a good Rotarian, before the anaesthetist squirted pentothal in his vein to put him under, he told me to give his apologies to our Club President because he was due to give ‘My Job’ Talk the following day.

BUSY SURGEON

As usual, as a busy surgeon cum executive director, I arrived at the meeting five minutes before it was due to start and told the President that I had operated on the scheduled speaker, and he had sent his apologies. The President, the late John Karmali, who was a well-known bird photographer, was not amused, and he exploded. ”How do you expect me to get a replacement at such a short notice?” He asked and added: “You landed me in this mess, and you will get me out of it. You will be the speaker.”

I had very little time to prepare my talk and thus decided to present my clinical cases, a funny one concerning a Rotarian, and a very sad one with a twist in the tale in layman’s language.

I started with the short funny one to put my fellow Rotarians in a receptive mood and judge their response. To make the presentation easy for my readers, I will present both cases as they happened rather than how I presented them in my talk.

It was about a 75-year-old Rotarian who sat next to me at a Rotary lunch soon after I was inducted. After a brief small talk, he asked me: ”I am courting a lady half my age and we intend to get married soon. As a doctor, what is your advice?”

I realised that he was after free advice and samples of aphrodisiacs, and replied. ”Take a lodger!”

FOLLOW-UP

After a few months, we happened to sit together and I asked as a follow-up. “How is the wife?”

“She is pregnant,” replied the Rotarian.

“And the lodger?” I asked.

“She is pregnant too.” He chuckled as the denture inside his mouth clicked!

Since a majority of my fellow Rotarians fell in this age-group, the true story got a huge applause, and I was emboldened to embark on my sad and long story.

It was about Shennaz, a 16-year-old girl who came to see me with her parents from Mbeya in Tanzania. Her pretty face was studded with pimples of puberty, one of which she was constantly peeling while she presented her medical history.

She was quite intelligent judging from the way she answered my clinical questions. She had noticed a painless lump above her left collar-bone for about a month, which had not responded to antibiotics given by her doctor. After listening to her full story, I examined the lump and diagnosed it as a gland and said to her parents:  “I think the gland needs to be removed and be sent to the pathologist to decide on the final diagnosis.” As they were conferring among themselves, I added: “The gland can be removed under local anaesthesia.” They readily agreed and I gave them an appointment to see me after a week.

LYMPH GLAND

I removed the gland the same afternoon and as usual cut it before putting in a bottle filled with a preservative. The cut surface was fleshy, an ominous appearance which the report confirmed when I saw Shennaz the following week. It was Hodgkin’s Lymphoma, dreaded primary malignancy of the lymph gland for which there was no treatment then.

 I did not know how to give her and her parents the shocking news when they least expected it, so I admitted her to softly break the bad tidings in small doses. After she left my clinic, I gave a short tutorial to my junior doctors on the poor prognosis of Hodgkin’s Disease.

That night my phone rang at 2am.  It was Dr Rajab, my house-surgeon on the phone. He said. “Sorry to bother you at this ghastly hour, but it is about Shennaz. I have been called to her ward because she is very breathless.”

“Have you seen her chest X-ray?” I asked, remembering that I had ordered it to be done on the way to the ward from the clinic that afternoon.

“Yes,” he replied. “It shows widening of the mediastinum, suggestive of glands there.”

“Give her a shot of cortisone, put her on oxygen and start a glucose drip; I will be with you in a few minutes.”

 I was going to put the receiver down when I heard him say some more. His volume went down a few decibels and he whispered. ”In view of your tutorial of this afternoon, wouldn’t it be better to let her go?”

Knowing that he was asking my permission to exercise passive euthanasia, I replied. ”We have not been granted the right to decide which of our patient should live or die. According to the Hippocrates’ Oath, we have taken our duty to sustain life.”

I have to leave my readers in suspense but promise that I will complete this fascinating story in the next column after a fortnight.

I want to assure them that this is not a gimmick to sell more copies of Sunday Nation, but I have reached my limit of 1,000 words and endurance as well!