Penumbra and Plums

One of the caveats about being a college graduate but not yet a medical student is that I am not qualified to do much else in a hospital setting beyond “shadowing,” i.e. observing. Given the fact that my shadowing experiences thus far at Kijabe Hospital have been some the most interesting and compelling of my premed career, I don’t mind in the least, but I am somewhat of a unique case in this particular setting. Kijabe not only serves as a referral hospital that provides specialized and emergency care to patients from all over Kenya, but it also functions as a training ground for medical students and resident physicians looking to further their training. As such, a natural question to be asked when getting to know someone here is “So what is your specialty?” or “What rotation are you doing here?” to which I feel a little sheepish in having to admit that I haven’t even started medical school yet. While I can go on to explain that I am helping to develop some data collection tools with the hopes of providing a means to compile some useful information on patients with certain conditions, my exact title eludes precise definition. Despite this penumbral situation, my excitement over the intensely life-changing potential of medicine has only continued to grow as I have seen, if only as a shadow, some incredible things over the past week.

            Being that I am working most closely with Dr. Erik Hansen, a pediatric surgeon, most of the cases I have observed have related to the treatment of children. One of the things I love about kids is their lack of pretense, but the flip side to their innocent approach to the world is their inability to contextualize pain. During one clinical session, I had to help secure a boy while a painful but necessary examination was done, and as I felt his entire body writhe and struggle against my hands, I could only imagine what a terrible person he must think I am at that moment. I think one of the most valuable aspects of shadowing, especially in a developing world setting, is the opportunity to see pain up close, as a reality and not just an idea. Before pain can be relieved, it has to be confronted and sometimes even intensified for a bit, neither of which are comfortable things to do. Another image that stands out in my mind is that of a little girl on the operating table with a tracheotomy waiting to be sedated for a scoping procedure. Some sort of stricture in the girl’s throat had threatened to prevent her from breathing (hence, the trach), and the scoping to be done that day was meant to explore the cause of the stricture so future operations might correct the problem, allowing her the ability to breathe and talk on her own in the best case scenario. Of course, sitting on a metal table in a room full of strange people wearing scrubs and masks is intimidating for almost anyone, let alone a little girl, so, as to be expected, she was crying before the procedure began. When I say she was crying, however, what I mean is that big tears were running down her face and her mouth was open just as if she were crying out, but no sound came out of her mouth. Instead, the only noise associated with her crying was the gurgling hiss (much like sucking up the last of your drink through a straw) that came with each inhale she took through the small white tube protruding from her throat. The pain I felt watching this girl was far outweighed, however, by the hope that the work being done for her would one day allow her not only the gift of breathing the air freely but maybe even the simple luxury of living her life with the ability to speak. It’s thoughts like these that help drive home the weight of practicing medicine: a few hours in an operating room may be the difference between a person living the rest of her life with or without the ability to communicate verbally. In one sense, it’s a sobering thought, but I tend to find it incredibly exciting.

My experiences thus far have not been strictly related to the hospital, however. There was one day last week when I decided I would do a little exploring, and so I started walking up the mountain road by which I had originally entered. About a mile into the hike, a railroad passes perpendicularly over the road, creating a one-car wide tunnel, and I noticed that a small dirt trail branches off the road and runs parallel to the train tracks. Thinking this might be a good route to find a nice overlook of the Rift Valley, I decided to see where the dirt path led. About half a mile later, I saw a group of four women and a boy heading towards me, so I stepped aside to let them pass. Exchanging nods, waves, and “habari’s,” I expected to simply move on once they passed, but the last woman held her hand out to me as I was about to go on my way. Thinking it was a handshake, I reached out to take her hand, but immediately I found three plums unexpectedly dropped into my palm. Surprised, I just smiled and offered an “asante sana,” and she smiled at me and walked on without ever breaking stride. Three plums the richer, I continued my hunt for a good lookout spot.

Embankments flank certain portions of the railroad, and on top of one of these, a clearing offered a place that fit the bill perfectly. Once there, I sat down to take in the view and enjoy the afternoon sun while the breeze played different tunes through the long needle pines. Just when I was starting to give some serious consideration to taking a nap, a band of young boys bobbed into view between the bushes lining the opposite embankment. At first I thought my presence had gone unnoticed, but their reappearance a few seconds later proved me wrong. One boy raised an upturned palm in my direction, basically asking, “What the heck are you doing over there?” I shrugged at him and waved. Discontent with not knowing, the same boy started scrambling/sliding down the steep dirt incline, crossed the railroad, and climbed to where I was sitting while the other two remained on the opposite side. All smiles, the boy asked me if I was waiting for the train, and I couldn’t tell if he was more amused or confused when I explained to him that I was simply walking and had decided to sit down here. I asked him his name (which turned out to be John), his friends’ names (Stannis and Emmanuel), and other small talkish questions when I noticed one of the other boys had dared to venture over as well. When I asked him “Habari gani?” he flopped on the ground in what I assume was his coping mechanism for the bizarre occurrence of talking with a strange white person and responded, “Mzuri.” After a few minutes, the boys were about to cross back over to the other side when I stopped John and held out the plums I had been holding. “Three plums, and one, two, three of you,” I said, handing them over. John and Emmanuel smiled and thanked me, dashing back across to share the spoils with Stannis who waved a stick at me from his perch. I sat there for a little while longer after the three boys had left, continuing to enjoy the view but enjoying even more the fantastic oddity of perfectly timed plums.