Susan’s tummy and the surgeon from Delhi plane

“I certainly don’t want an abortion,” the father roared. “And I don’t want the pregnancy to continue and be lumbered with a baby at the end,” the mother said. ILLUSTRATION | JOHN NYAGAH

What you need to know:

  • He led me to their bedroom and introduced me to his wife. “Darling, this is the surgeon from Delhi; he has graciously agreed to put a hand on your tummy.”
  • He made a quick exit, saying, “I will leave him to examine you.”
  • The recognition was instantaneous and mutual. “It’s a small world,” she said.

I have written in this column before about how my long practice has conferred distinct advantages on me.

One story stands out; me operating on the matriarch of the family when I had just started my surgical career in Nairobi and operating on her great grand-daughter just before retiring!

Susan’s story belongs to the same category, though not to the same extent in the span of time.

In my younger days, pregnancy before marriage carried a major social stigma, so when the missionary couple from Canada found their only daughter with a bulge in her tummy growing by the day, they were panic stricken.

They prevailed upon their family doctor, Irene Gitaka, to refer the patient to me as a fast growing “lump in the abdomen”. So Irene rang me to explain, prior to booking Susan to see me.

“I have this strange case on my hands. It is a straight-forward case of six-month-old pregnancy in a girl of 13 but the parents can’t come to terms with their unmarried daughter carrying an advanced pregnancy, so much so that they want me to refer her to a surgeon.

"I dare not even do a pregnancy test, order a pelvic ultrasound or refer Susan to antenatal clinic where she belongs because it will hurt the parent’s sensitivity. I reckon they are an old-fashioned couple and can’t accept the generation gap.”

Then with a touch of sycophancy, Irene concluded. “With your seniority, you can talk to the parents and put them right.”

DOCTOR'S APPOINTMENT

In due course, Rev Carruthers, his wife and daughter came to see me. I would have liked to interview Susan alone but, considering how over-protective her parents were, I decided to take her medical history in their presence.

Just as well, because Susan acted dumb and they filled the gaps.

“How long have you noticed the lump?” I asked.

As Susan remained silent, the mother provided the information. “My husband and I noticed it about three months ago.” Then she added a precautionary note. “Mind you, it could have been there for longer.”

“Initially we thought that it was the normal growth which accompanies puberty,” she added.

The father came in: “After all, she was spurting in all directions.”

That led me to ask something I was going to inquire later on. “Has Susan started her periods?”

“Strangely, she had one period and then nothing. Naturally I thought that at the onset of menarche the periods are irregular until an individual pattern is established,” said the mother.

I asked for other pertinent details and then asked Susan to get on the couch for me to examine her. I drew the curtains to get out of the hearing range of the parents and decided to take the bull by the horns and asked Susan. “Could you be pregnant?”

“I don’t know,” she replied.

My examination confirmed that we were dealing with a case of six-month-old pregnancy in a girl of child-bearing age. I decided to take the same direct approach with the parents and said to them. “I am afraid Susan is pregnant.”

PREGNANCY TEST

The parent’s reaction was as I expected. The father wondered how he was going to face his congregation and the mother added: “When the periods stopped after appearing once, I knew Susan was brewing something. I wish I knew how it happened.”

“This is no time for recriminations or apportioning blame,” I said, “but to find ways on how to deal with thefait accompli.

Since I did not hear any objection, I continued: “Let’s do a pregnancy test and hope that I am proven wrong.” I said it to inject some humour into this sombre situation.

“If I am proven right, I will tell you what I intend to do, subject to your approval. Along with the pregnancy test, I would order a pelvic ultrasound which will tell us the age of the pregnancy. Finally, I would call a gynaecologist in joint consultation.”

The father interjected at this point. “I certainly don’t want an abortion,” he roared.

“And I don’t want the pregnancy to continue and be lumbered with a baby at the end,” the mother presented her point of view.

I responded to both viewpoints. “I think the pregnancy is far too advanced for an abortion. As for continuing the pregnancy, let us wait and see what the gynaecologist has to say.”

I had formulated a plan but did not think it wise to divulge until the results of the pregnancy test and ultrasound arrived and it was time to introduce a gynaecologist into the equation.

As expected, the pregnancy test was positive and the ultrasound timed the pregnancy to be about six months old.

The parents left me to decide on the gynaecologist of my choice and I picked Dr Lynn Ogutu, with whom, ironically, I was collaborating on investigating and treating infertile couples.

ADOPTION

When Lynn and I saw Susan and her parents, Lynn agreed with what I had told the parents. When it came to what to do next, I suggested: “It should not be difficult to get the baby adopted.”

“Where are we going to hide Susan until that time?” the father asked.

“We could send Susan out of Nairobi for the last two months when the pregnancy is very visible and also her confinement,” the mother replied.

“I would like Dr Ogutu to deliver the baby,” I suggested.

“In cases like this, we do a Caesarean because, at the tender age of 13, we don’t want the mother to suffer the rigours of normal labour. We do it at eight months of pregnancy because the baby is viable then,” Dr Ogutu said.

“We can arrange for the adoptive parents to pick the baby the next day from the hospital.”

After a long discussion, it was agreed that Susan would go to Kisumu to another Canadian missionary couple who would be sworn to secrecy and, at eight months, Susan would return to the hospital in Nairobi and after Caesarean Section would stay at our house under the care of Marie until she was strong enough to go home.

Everything went off with the precision of a Rolex watch. In due course, Rev Carruthers was recalled to the headquarters in his hometown, Toronto, and Susan’s file went into my archives.

Twenty years later when I attended a surgeons’ conference in Delhi, the direct flight from Delhi to Nairobi was not available for two days and I had a couple of spare days.

I decided to fly to Kashmir, which I had not visited before. My travel agent managed to book convenient flights but had difficulty in reserving a houseboat.

She said: “The best I can do is to book you a bedroom in a houseboat reserved by a Canadian couple who are happy to share it with you.”

“I will take it,” I had to decide quickly.

TUMMY UPSET

I arrived quite late in the evening and ran straight into the Canadian gentleman who was sitting in the balcony alone. “Boyd is my name.” He welcomed me warmly and added: “William Boyd. You must be the surgeon from Delhi.”

I wanted to clarify that I originally came from Kenya but he was keen to say something more and continued.

“My wife is indisposed with what we think is a tummy upset.” Then, as an afterthought, he added.

“Now I know as a surgeon you don’t dabble in mundane things like tummy upset but I wonder if you wouldn’t mind putting a hand on Susan’s tummy and confirm that it is nothing more.”

All this time I was looking at the beautiful Dal Lake which was like a basin of serene water surrounded by snow-capped mountains. In the milky moonlight, the clouds seemed to be bending down to kiss the mountains.

In the water, there were shikaras, small rowing boats taking young romantic couples on their run on the lake. I remembered the Persian couplet which said — If there is paradise on earth, it is here, it is here, it is here.

It suddenly dawned on me that Boyd was waiting for a reply. “Not at all,” I said.

He led me to their bedroom and introduced me to his wife. “Darling, this is the surgeon from Delhi; he has graciously agreed to put a hand on your tummy.”

He made a quick exit, saying, “I will leave him to examine you.”

SMALL WORLD

The recognition was instantaneous and mutual. “It’s a small world,” Susan was the first one to recover.

“Small world, indeed,” I agreed.

“You haven’t said anything to my husband, have you?” Susan asked.

“My lips are sealed by the Hippocrate’s Oath,” I replied. “Now let me put a hand on your tummy.”

As she lay on her back, I saw the Caesarean scar and asked: “How did you explain this?”

“Blamed it on a difficult appendix,” Susan explained.

“Tell me what happened after your family left Nairobi,” I said.

“My parents never forgave me for my pregnancy, so I left home and took a secretarial course and joined a bank as the manager’s secretary. That did not last long because soon he asked me to marry him.”

“I better tell your husband that it is no more than a tummy upset and relieve him of his agony,” I said and left. I also wanted to clarify that I was a surgeon from Nairobi and not Delhi.

I joined Boyd in the balcony and assured him that his wife suffered from tummy upset and should recover soon.”

“Did you see the terrible scar the Kenyan surgeon left while removing Susan’s appendix? he asked.

I changed my mind about explaining that I was a surgeon from Kenya!