Surgeon's Diary: Saga of dying patient that won me this column

As I said in the previous column, this is a continuation of Shehnaz’s saga. When I arrived by her bed, I could see that she was in a critical condition and fighting for air. Dr Rajab looked pale and distressed; he was a recent graduate from Makerere doing his surgical internship and facing a dying patient for the first time. Looking at the hustle and bustle around her, suddenly Shehnaz said. ”Dr K I don’t want to die.” She was using the name by which I was known as at the Aga Khan Hospital.

“We won’t let you.” I replied with a lump in my throat.

With a shot of cortisone and more added to the drip, we revived Shehnaz. As she inhaled oxygen without effort, I drove home hoping to catch some sleep because I had a long operating list in the morning.

But sleep eluded me because of Shehnaz’s poignant words. I switched my bedside light on and picked a copy of ‘British Medical Journal’ (BMJ) still in its wrapper from my bedside table and opened it randomly.

TOOK A SHOWER

Staring straight at me was a research article titled ‘Result of quadruple chemotherapy in Hodgkin’s Disease’’. I read it, re-read it and jumped out of bed with joy, took a shower and got ready to go to the hospital. Dawn was breaking as Marie, amazed that I had varied my routine, served me with my frugal breakfast with papaya, mango and cereal.

I walked straight to the pharmacy, put the relevant page of BMJ on her desk and asked the night pharmacist if the drugs were stocked in our pharmacy. From her face, I realised that she had not even heard the names of the drugs. I left a message for the chief pharmacist to ring me when she arrived, and went to the ward to see Shehnaz and her parents.

By now she was no longer in crisis and her parents were resting comfortably by her bed. I gently told them of Shehnaz’s diagnosis and handed them the BMJ to read. When they finished reading, I told them, “In case the drugs are not available locally, I will fly them from London.” As they nodded their approval, I warned them: “The side effects, as described in the article are horrendous and Shehnaz might get them all.”

“I am prepared to start the treatment as soon as the drugs are available.” A resolute and determined reply emanated from Shehnaz’s bed.

She received all the four chemotherapy drugs in doses mentioned in the research article and developed severe side-effects. She vomited incessantly, developed severe diarrhoea and lost all her hair, a distressing symptom for any woman, especially a girl of her age.

The probationary nurses in her ward gave her a wig as her 17th birthday present, which she had in the ward during one of her four courses at monthly interval.

I was very worried when her haemoglobin dropped to 10 per cent, her platelets to 10,000 and her white blood corpuscle from 10,000 to merely two. I rang the researcher at the Royal Marsden Hospital in London and she told me to persist – cautiously!

RECESSION

She also needed radio-therapy to shrink her chest glands, available at Kenyatta National Hospital only at the time. After four gruelling months, she went into recession to everyone’s relief. Eventually, Shehnaz’s family left Tanzania after Mwalimu Nyerere nationalised farms and property, and settled in Toronto.

Dr Rajab was expelled from Uganda with other Asians, and was accepted by Canada as a refugee. He found a job in the cancer unit in Toronto General Hospital.

 Before Shehnaz left Mbeya, she came to see me and I gave her a referral letter to Toronto General Hospital. There she met Dr Rajab, they fell in love and got married. Because of their happy connection with Kenya, they came for their honeymoon here.

Marie and I invited them for dinner at Muthaiga Country Club.  When Marie escorted Shehnaz to the ‘ladies’ to powder her nose, Dr Rajab whispered something in my ear, which will remain etched in my memory for as long as I live. He said. “Thank you for not allowing me to let her go the night I rang you!”

When I finished narrating the story, my audience gave me a standing ovation, with some members dabbing their eyes. Among them was Joe Rodrigues, the Editor-in-Chief of the Nation group of newspapers. He came to see me and the rest is history.

PINK GINS

I had brought him into Rotary a few years back and now he was a member of my Club. He saw the ovation and seized the opportunity. Usually, members, some of them octogenerians, after a couple of pink gins and a sumptuous three course lunch dozed off, but they were riveted to their seats while I spoke, and were lining up to congratulate me on my off-the-cuff performance. Joe asked me if I could put my talk in writing. “I spoke from my heart, but I will try.” I replied. I did it that evening and sent the typescript to Joe. He phoned me the next day and said. “You are on!”

“On for what?” I asked.

“For years, I have been looking for something like this to start a regular column in Sunday Nation,” he replied. The rest, as they say is history and the first ‘Surgeon’s Diary’ titled ‘The eye of a needle’ appeared on May 25, 1980, a day after Marie and I celebrated our 22nd wedding anniversary.

 The column has been running since and is in its 40th year, and this is the 982nd column in the series. I intend to write 1,000 before I retire, better still, until the faculties, eyes, brain and fingers, needed for writing, allow me!

I must end by mentioning how this column got its title. When the idea of running a column of my clinical cases was mooted, I had some grandiose titles like Pearls from my Ocean, Roses from my Garden and Stars from my Sky in mind.

Rashid Mughal, the then Features Editor of the Nation, brought me down to earth and christened it ‘Surgeon’s Diary’ and it took off like wild fire, still burning and nobody wants to put it out! None of us thought it would last as long as it has.