There is a queer group of patients I have observed.The armed! 

Not because it is unlawful to be armed ( licensed gun holders and all), but due to the shock and  surprise they bring to the village surgeon’s face. 

Countless are the times a patient has unbuttoned his shirt as he got to the examination couch only to reveal a pistol tucked under his belt.

Granted, a few will belatedly apologise for not forewarning you.

Of course the surprise is barely existent if the patient in question is a member of the security agencies.

Senior Citizen with a Billao 

Now a few months back, I had a similar encounter, but a different weapon. 

A senior citizen walked into the consultation room. He had been referred to me by the oncologist.

I requested him to take off his jacket and lie on the couch so I could examine his abdomen. 

That is when the Somali shortsword came to view.

Luckily this time, I was in awe, not in shock. 

Growing up in Meru North I interacted with the nomadic pastoralists from Isiolo and beyond and gleaned  a great admiration of the Billao ( as the shortsword is called). As a matter of fact I have been searching for one, though not with the seriousness that gets you one.

He did not apologise. I admired the sword and asked if he could help me procure one just for personal home use.

I digress.

Recurrent Rectal Cancer 

The reason for his referral to me was a recurrent cancer of the rectum. He had had surgery just half a year prior, meaning either the cancer was not adequately cleared during surgery or it was so aggressive it had recurred so soon. I confirmed the former.

Having noticed how close to the gate valves of stool ( anal sphincter ) the cancer was, the surgeon had advised excision of the entire rectum and anus and creation of a permanent stool outlet on the belly skin. 

The old man was not comfortable. He would rather the surgeon did as much as he could to leave his intestines draining out through the natural aperture.

The last thing he said to the surgeon before he went under anaesthesia was, “do whatever it takes to ensure I do not leave this theatre with a colostomy,” I later learned from my colleague.

So the surgeon did the best he could but that best was not good enough to get out the whole cancer, as we would painfully learn later. 

I felt a huge tumour less than two inches  into his rectum. It was agonisingly close to the sphincter and there was no way out but to remove the whole rectum and anus, a major procedure called abdominoperineal resection

He had been told this countless times. I was the fourth doctor giving the same message. That is how he had landed in the oncology clinic, chasing the option of chemotherapy. The oncologist had then requested my input. 

Elders’ opinion on Surgery 

After a moment of exchanges and brief soul-searching, he needed to get back to his home and discuss with family, friends and fellow elders on whether to accept the surgery. I agreed. 

We said good byes and he promised to get me a brand new Billao during his next appointment. He would accompany the sword with his decision about the surgery. 

He took my card and promised he or his son would call, if need be. 

I am yet to see him. I am yet to hear from him or his son. 

Another day in the fight against the menace that is cancer.

Another lesson in the respect of patient’s autonomy.

Another list to the litany of the weapons that land in a surgeon’s consultation room.