Leg amputation helps reconcile estranged ‘white hunter’ couple

Once upon a time, I had a wife but looking at my job and perks, she soon realised that she was superfluous in my life and returned to her parents. ILLUSTRATION | JOHN NYAGAH

What you need to know:

  • The right leg was relatively cold, coppery in colour, with touch, temperature and pain sensations impaired.
  • When I squeezed his calf muscles, he complained of pain. All the pulses in that lower limb were feeble.
  • Then, I turned my attention to the left leg, which was obviously gangrenous.
  • It was dry gangrene; the term denoted no infection in contrast to moist gangrene found in diabetics, which is infected and emits a foul smell.

This story about a white hunter will take us back a few years when they thrived. This species is now extinct.

I suppose the term ‘White Hunter’ was devised because most, if not all, were Caucasians and they arranged trips for rich and famous Americans and Europeans to legally hunt wild animals in designated areas.

The tourists hung the heads and skins of the hunted elephant, lion or ‘rhino’ in their lounge back home as memento of their visit to Africa and brag to their guests about it.

One afternoon, Mr Saunders, a white hunter, arrived on a stretcher in the casualty department of the hospital in which I had an office, with a note from his doctor addressed to me.

The Casualty Officer called me and I complied with his request to go and see the patient immediately.

“It is not a dire emergency but from what I can see the man has a gangrenous leg.” He added a rider to his request.

On arrival in the Casualty, after greeting the patient, the doctor and sister in charge, I eagerly read the note from Dr Bosire to obtain the necessary information about her patient and also her notes were interesting, with a few literary gems thrown in.

THE FLESH IS WEAK

On Saunders, the note said: ‘Herewith, Mr Saunders, my patient for 25 years and a heavy smoker with dry gangrene of his left leg. I have been periodically seeing him with intermittent claudication for the past five years and, going by his heavy smoking and ethnicity, diagnosed him as a case of Buerger’s Disease.

I ordered an aortogram which confirmed spasm of the arteries of lower limbs which were clogged by thrombi.’

I was looking for a literary quote but it came in the next paragraph which said: ‘I exhorted him to stop smoking and assured him that the disease is reversible even in late stages, as it was in his case. Unfortunately, the spirit was willing but the flesh was weak and the disease has relentlessly marched to its conclusion. Over to you,’ it concluded.

To explain the technical terms used by Dr Bosire, ‘intermittent claudication’ means pain in the calf muscles on walking, which subsides with rest but resumes on walking again.

Aortogram is an image of the aorta, the main large artery in the body. The other name for Buerger’s is thrombo-angiitis obliterans, which describes the pathology more vividly.

Smoking causes inflammation of the arterial wall which is followed by formation of tiny clots which in turn obliterate the artery, causing intermittent claudication to start with and eventually lead to gangrene due to less blood flow to the limbs.

Having read the doctor’s note, I embarked on my history taking, assessing the patient as I was doing so.

SAFARI

He was tall and I put him at six foot plus.

His complexion was ruddy and his face was deeply wrinkled, betraying the outdoor life he led in our hot sun, as demanded by his job. He wore a safari suit with half sleeves which came down his long shirt sleeves in cheque material.

He sat on the couch with his matching shorts, exposing both his legs, one looking relatively normal and the other one showing dry gangrene up to the middle of the leg.

The yellow stains on his fingers and his rotten teeth confirmed that he was a chain smoker as mentioned by his doctor. I suspected that he was also an alcoholic from his bibulous breath. His medical history corroborated what D. Bosire had written in her note.

It was when he talked about his work when I learnt interesting things about a white hunter’s life.

“My job entails taking tourists on a hunting safari. We travel in a Land Rover and pitch tents when we reach the designated area, teeming with wildlife including the Big Five. Late in the evenings, we have a barbecue under a clear African sky. Booze, smoke and sex come easily and in abundance in my job and I indulged in excess of all the perks attached to the job.”

“Did you do any work?” I asked.

To which he replied. “Yes. Early in the morning, I would take my clients in a Land Rover looking for lion, elephant or rhino. Some days we returned empty-handed; on other days we bagged enough trophies to satisfy the customer.”

ALL ALONE

Saying that, by dint of habit, Mr Saunders brought out a packet of cigarettes from the bulging pocket of his safari suit, but looking at my reproaching face, he changed his mind and returned it to the same pocket.

Having obtained the medical history, I examined Mr Saunders, especially both his legs, the "normal" one first, in accordance with my teaching to my students.

The right leg was relatively cold, coppery in colour, with touch, temperature and pain sensations impaired. When I squeezed his calf muscles, he complained of pain. All the pulses in that lower limb were feeble.

Then, I turned my attention to the left leg, which was obviously gangrenous. It was dry gangrene; the term denoted no infection in contrast to moist gangrene found in diabetics, which is infected and emits a foul smell.

It is believed that the sweet blood of diabetics attracts bugs. I looked at Mr Saunders and, before giving him a shock about amputation, I asked: “Is anybody with you?”

In reply he poured his heart out. “I have no blood relatives here.” Then he elaborated.

“Once upon a time, I had a wife but looking at my job and perks, she soon realised that she was superfluous in my life and returned to her parents in Devon, England. There were no recriminations, no divorce and no ill feelings. We still kept in touch, exchanging birthday and Christmas greetings. If I give up my job as a white hunter, she will be back here in a jiffy.”

NEXT OF KIN

“Can you get her here to support you during surgery?” I asked.

“How can I ask her after the shabby treatment I have meted out to her?” He posed a rhetoric question. “Anyway, what surgery do you intend to carry out on me?”

“That leg needs to come off.” I replied. “It is useless and dangerous and I am scheduling the amputation tomorrow morning.”

As I drove home that evening, the case of Mr Saunders haunted me like a ghost in the night until I made a decision to shake it off.

Next morning, I went to the ward where Mr Saunders was lodging. I just caught him in time for he was already on a stretcher and going to the theatre in the company of a ward nurse and theatre orderly who had come to fetch him.

I took Mr Saunder’s file from the nurse and opened it. I was glad that my hunch had been proven correct. In the "next of kin" column was the name of Mrs Saunders with her UK phone number. I made a note of it.

As soon as I reached the surgeon’ changing room, before undressing, I asked the hospital telephone operator to get me that number.

There were no mobiles in those days and knowing that the hospital was very strict on overseas calls because of the escalating monthly telephone bills, I added. “This is an urgent call and if there is any query, I will pay.”

I waited for the call while I was changing. When it did come, it was Mrs Saunders’ mother who answered the phone but she put her daughter on the phone when I told her: “This is a surgeon from Nairobi and I want to talk to your daughter about her husband.”

Fearing the worst, she immediately called her daughter to the phone. After exchanging polite greetings with her, I informed her.

“I am speaking from the changing room in the operating theatre and I'm scheduled to amputate the gangrenous leg of your husband.”

I then softened my brutally stark announcement. “As a surgeon and a human being, I know that this is the time when a person needs family support, because amputation of a limb is a shattering blow to any man; It is like a woman losing her breast.”

THE VISIT

Mrs Saunders wanted more details from me but to spare the impact of my statement from dilution, I said. “I must rush because everybody in the hospital knows what a punctual surgeon I am and my anaesthetist starts inducing anaesthesia once she knows that I am in the changing room.”

Two days later, I saw the result of my daring adventure into the family life of my patient.

When I went to see Mr Saunders, two days after his amputation, the ward sister told me that Mrs Saunders had flown from England to see her husband and was waiting in her office to see me when I finished the ward round.

I couldn’t wait to meet her and said to Sister. “I will see her before I start,” I said.

She escorted me to her office where I met Mrs Saunders. “It was kind of you to inform me about my husband,” she said.

“I am glad you flew to see him because he was missing you,” I replied. “How long are you here?”

“I am here for good.” As she saw my stunned face, she elaborated. “My husband and I had a long chat. He does not think he can go to his old job after an amputation and since that was the only bone of contention between us, we have decided to reconcile.”

Then she sighed and added: “We are both sorry that we have lost our golden years. We are a pair of burnt-out cases.”