It all started with a phone call from the nurse covering the night shift.

‘We have a 19 year old with strangulated groin hernia!’

That meant I had to leave the Toastmasters District Executive Meeting going on and rush to the emergency room. 

It was during the finance manager’s report and my mind had started spinning at the sight of the various columns and figures displayed on the shared screen anyway. I got an excuse to mute, stop video tip toe away incognito.

When I got to the emergency room, there were two patients who fit the definition given. Every doctor knows how the adoption of face masks by patients has taken away those battle hardened ‘first impressions’ that we call spot diagnosis-the capacity to tell a patient’s disease (or at least hazard an educated guess) by just having a millisecond look at their face.

‘Habari zenu nyinyi’, I heckled as I asked to be shown to the patient.

The clinical officer was finishing up with fixing an IV canula and drawing some lab samples.

After the moment of waiting, I eased my way to his bedside. He did not appear in obvious pain. 

He Studied my name tag carefully

‘Good evening Sir’. 

I was immediately impressed by the fact that as he responded, he studied my name tag carefully.

‘Good evening to you Dr Stanley’, he replied.

That was great! I did not have to introduce myself with my tongue-twisting surname and title.

He briefly told me how the attack of his groin pain had struck 6 hours earlier while doing some gardening. He had slept for a while but the pain did not subside. And there was a bulge; previously on and off but  now constantly there. 

We would try to reduce the hernia under some strong pain killer at the emergency room then do the surgery first thing in the morning, I informed him as I inspected his crotch. Otherwise we would proceed to theatre. I also explained the dangers involved with his surgery. To which he was stone faced as he sought assurance that he would be able to bear children afterwards.

‘You should’, I reassured. 

He had already received a shot of morphine. Now I advised some diazepam.

My attempts at reducing the hernia were met with swirls and body contortions.

His apprehension did not help matters. Even when he was sleepy my attempt at reducing the hernia were met with the swirls and body contortions of a man possessed. I threw in the towel and opted for the blade.

The nurse covering was within reach. 

‘Let me know when we have the theatre team ready.’ 

I sped back to the house and met the meeting just concluding with the finance manager’s report. I was in time for quite a number of other agenda items as I awaited the call with the all familiar phrase ‘Theatre is ready’.

‘Should I come running or walking?’ 

‘Do not run’. My nurse covering reply meant that probably not everyone was in theatre. It is another trick you learn with emergency surgeries. They say the team is ready when everyone has confirmed they are on the way. Not always sure if it is the way from bedroom to the door before heading out for the hospital.

I met the anaesthetist in the changing room and we joined the rest of the duty team in the operating room receiving area.

It has reduced!


It has reduced! Two theatre staff announced in unison. 

We decided to proceed to surgery anyway as all the resources had been summoned instead of postponing it to the following morning.

At our introductions in emergency department, and as a way of assessing the effect of the sedative, I had struck a conversation with the chap about his education. He was an engineering student at a local university.

As we got started with surgery, I was curious to learn how the hernia had reduced. Most of the time the patient just sleeps and does not even realise until they wake up and they are back to normal.

It turns out that the young chap had actually massaged his hernia slowly until he reduced it. He had perfected the art for months now. 

Knife to skin and we are on. The procedure is herniorrhaphy (apologies to your tongues). I revisit the schooling conversation since he is not anxious at all.

I will build the first Kenyan Subway

When I ask him about his dream project, he says that he would like to design the first Kenyan Subway system. It will run parallel to the Thika super  highway. The other routes will run parallel to the bypasses. The central hub will be in the underground of the present Nairobi Central Business District. 

How will you execute this?

‘ I will design then hand it over to the government with a clean heart’.

Impressive!

‘Well, I have also found the subway through which your future children will travel’, I announce to him as retract the spermatic cord to free the hernia for repair.

‘Is the first born going to be a son?’ 

‘Shut up, we are serious here!’ 

The cheap talk has to be brought to check as a colleague  gynecologist is in the room waiting for the same team to join him in performing a ‘vaginal bypass surgery’ ( this is what I baptise Caesarean deliveries conducted by specialists. Do not tell any of them).