Resurrection

I am aware of a certain tendency I have to write about "bad" things, suffering and death and things that go wrong. So, in this Easter season, here is a story about a kind of resurrection.

Jackson is 76 and a man of few words. He was brought to the hospital a couple of weeks ago, and all I could get out of him was, "Sina nguvu" ("I have no strength"). The full story took several days to emerge, perhaps slowed by my lack of language skills, but eventually helped by Jackson's advocate, one of our pharmacists who comes from his village. It seems that he had been getting noticeably weaker over the last 3 months, with a gradual but definite decline. More recently, he had been stumbling and even falling, becoming forgetful, and then incontinent. I couldn't find anything on exam or basic labs, and my first thought was this is just what happens when you hit 76 (the prejudice of the young against the old). However, during the several days it took for the full story to emerge, he was getting day-by-day visibly worse, until finally he couldn't get out of bed or even talk. At this point I suggested to the family that if we really wanted to know the cause, he would have to get a CAT scan, which could only be done Eldoret (an hour and a half away) and would cost about $60. And of course even if we knew the cause, there was no guarantee that we could do anything about it. I thought their answer would be no, but to my surprise they were able to raise the money over the next couple of days, and off he went.

He returned with the CAT scan showing the largest sub-dural hematoma (a blood clot between the skull and the surface of the brain) that I have ever seen. The treatment is to drill "burr holes" in his skull, removing the clot, and relieving the pressure on his brain. Now what?

It turns out that one of the things that has changed dramatically for the better is the availability of surgery. Dr. Legeyo, the government district surgeon (a general surgeon, there are no neurosurgeons outside of Nairobi), was here the next morning to "do the necessary". By the next day, Jackson was sitting up, starting to talk and, by the following day, even starting to walk.

This contrasts with a patient we had in 1994, still vivid in my mind. He was a young man who had hit his head in a workplace accident, and had the same type of problem but much more rapidly progressive. Over the next 48 hours, he went through all the textbook stages of excess pressure on the brain from a hematoma. But in those days, there was no CAT scan, and no possibility for referral. I had even resolved that it was better to attempt the burr holes myself (my do-it-yourself surgery book said they are easy) than to watch him die, but without the proper equipment it was not possible. And so he died...

Of course, for Jackson this is not really a resurrection, but (with luck and rehabilitation) simply a return to his previous level of 76 year-old function. Still, a modest success, and an illustration of how some things have changed for the better over the last 15 years.