Up on a hill

Up on a hill
- garland of crop and flower as neck,
the Eagle dwells
House of twigs and thorns
her rounded iron beaks
make into feather beds for her young.


I remember!


Young birds thrown gently over rocky cliff
Forced to fly
with wings not dry


Mother soars above—eyes watching
Sharp!
Glides in, gentle breeze
lest we break.
Rock-solid span
soft, comfortable, sure!
Unlike the rockier death to which we plunge
our dance
of life and death


Can I ever marry?
Would my heart anyone else love?
A taste of you
is the first drop of rain
that teases the parched, broken land
that is the landscape of my heart
whispering of the louder downpour
blood through venous cracks
giving life—and mending


I thirst some more!


Nurture the new plant—green
head high, stem straight without a bend
Give the adult strength
to make its food
Independence!!

So what locks my jaws—strangles me
prevents me from telling
I sing your love
speak my love
for you on your hill
The world hears, its heart listens, feels
The ear that’s valued the most
becomes the island
wondering, feeling, wondering

About a son’s love


Prime
*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************

Musings from my time away – Akpa evelia (second part)

Hi, my name is Akpa evelia. If you have not read Akpa gbator, it may be difficult for you to know me. But if you are brave anyway, here goes ...

Next up were Neurology, Psychiatry and Radiology. Neurology was a large field with many unknowns but it made a lot of sense to me. In many ways, it was logical. Like 1+1 = 2 and very rarely was it something else. It could be summarized in deficits or excesses. Deficits naturally were the easiest to see as in strokes when someone suddenly cannot use an arm or cannot feel temperature differences or touch on a part of the body. Reasoning through the losses and what normal function is, one can usually pinpoint which region of the nervous system the problem lies, something called “localizing the lesion”.

Excesses are much more difficult to notice. For example, when does an old lady who suddenly becomes hypersexual and happy come to attention or when does someone with repeated vocal ticks and a propensity to burst out in curse words realize it is Tourette’s syndrome? Much has been achieved in the medicine of the nervous system but a lot still needs to be done and I found it difficult to come to terms with the futility of a lot of it. We could determine what the problem was in most cases. We could not always treat them. One of my patients died with us knowing neither what caused his problem nor how to definitively treat him.

The most important thing I found in Psychiatry is we all have mental problems to an extent and if you dig below the surface, you could very easily come up with a diagnosis of yourself. It is also not for me. Radiologists are some of the smartest people in the medical field and not only because they make the best lifestyle decision of us all. The breadth of differential diagnoses they have to know is beyond belief and they know more than just the names, they know the pathophysiology and they know the best management practices. They are everyman’s doctors with no direct patients.

The best, and the reason I have been incognito for the past 3 months, was saved for last. Surgery was the light at the end of my proverbial third year tunnel. Since I was a child, I have wanted to be a surgeon. The simple idea of getting into a person’s body, fixing a problem and closing up like nothing had happened in the first place was just amazing to me. It is as good as instant gratification goes. As I grew, I got more and more excited about the heart. I saw a heart come back to life after being stopped for surgery and oh my! It was poetry in motion. But I jump forward. Let me rewind for a second.

My surgery experience ran the gamut from an attending telling me she would “take away [my] scissors if [I] cut like [I] did again” and duly taking it away on the next cut then not saying a word to me for the rest of the day’s surgeries outside of sending me to get her camera for a picture of an interesting pathology, through opening the six pack muscle to enter the abdominal cavity to resecting a lipoma, replacing a hip and suturing multiple incisions closed. Through all this, I never did tire of cutting into human skin…for good, of course.

I would have to say as a pre-clinical student, I thought watching a surgery was incredibly boring. I did not understand a lot of the pathophysiology, I did not know much about the procedures and in many cases, I could not even see what was going on. However, once I got into my third year and started putting together the link between pathology and physiology, it was easier to think through what procedures were going on, how the problem would be approached, why surgery was indicated in the first place and most importantly, the anatomy of the situation. In addition to this, I started looking at how surgeons exposed problem areas, how they were holding instruments and what instruments they were calling for during various parts of the surgery. And of course I thought through what the anesthesiologist was doing.

Let me tell you a typical day. I woke up at 4am, got to work by about 5am to pre-round on all patients on the team. This involved getting their vital signs, fluids in and out and for my patients, reading through the consult notes from the previous night, checking out on events overnight and writing a preliminary plan of action for the day. I was lucky to have another student, “Goose” to my “Iceman”, on the team and we could very easily divide and conquer. I felt the sting when he moved on to another service. We rendezvoused at 5:50am with the Intern and then rounded with the Senior (Boss – he hates it and this is the last time I will call him that) at 6am. Then we did “gravity rounds”; starting with the patient on the topmost floor and ending down on the surgical floor. Our role as we saw it as students was to get the patient charts, do dressing changes, get pimped (tested on multiple surgical and non-surgical knowledge) and in general make the morning a smooth and enjoyable one for our team.

7am saw us in rounds where we went through the trauma admissions of the previous night and the cases for the day and then we were off to the operating room of which you have heard enough. Suffice it to say, there was a totem pole and we were at the bottom of it. Our work mostly involved transferring the patient onto and off the OR bed, transporting them to the post-anesthesia care unit and in-between, cutting stitches and retracting other organs out of the way so the surgeons could get a better view of what they were doing and if we were so fortunate, getting further pimping. And NEVER contaminating the field.

And here-in lay the bane of the medical student’s OR existence. The circulation nurse. Yes I have been lucky to have the best of them. The ones looking out for you and the ones who were only vested in your success, helping you maneuver the OR adroitly. Yes I have also had the worst including those who invented more and more ingenious ways to charge you with being “contaminated”. You remember that totem pole in the OR? The circulation nurse, see, is on top of it. They are the people tasked with setting up the operation room, getting things and people moving and overall, making the operation a success. And they take their work seriously. If you are ever in an OR, make sure you have had your orientation and know who they are. Ask what you can do to help, get the temperature of the situation and act accordingly. One source that helped me with this is found here. Seriously though, a lot of them are very nice people who are more than happy to teach you and you should learn from them.

Back to the time line. Between cases, we checked on our patients “post-op” to ensure we did not screw up that physiology or the other anatomy. Then it was off to didactic lectures at 1pm during which we ate lunch. The rest of the day was spent either in cases, managing the patients on the floor or answering consult requests. We sign out to the night team at 6pm and go home to begin in another few hours. For the medical student, that meant dinner, and hitting the books for however long you spirit or body could take. Then sleep beckoned and before long, the annoying alarm goes off and you are back again.

As far as my personal experience, it was awesome. I have to say these were the most brutally honest people I have ever worked with and that was refreshing even if it meant there were harsh critiques half the time and I felt worthless the other half. I had, most of the time, teams with doctors who were committed to the philosophy of education and challenged my thinking, knowledge base and surgical skills. They also gave me a lot of responsibilities during cases, handing me large parts of the simpler cases and making me experience first hand, the art and science of what the French call Chirurgie. It is a time I will always cherish and most of the people will be remembered by me through my career. Above all, what made surgery great for me, and what keeps me excited about it, is seeing the problems in peoples’ bodies with my eyes and then seeing them solved. As one Senior said to me after we witnessed a ventricular fibrillation, “internal medicine doctors can only read about this in books”.

Prime

*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************

Musings from my time away – Akpa gbator (first part)

Hello, good day, how have yall been for the past 3 or so months? Yes, that is how long it has been since my last post and no one has been more cognizant of those months than me. However, since you, my loyal readership deserve better than spotty writing, I would like to apologize for my unannounced hiatus and ask that you continue with me as we resume this journey. So let me tell you what I did in the time I was away. The short of it is I completed my General Surgery Rotation to wrap up third year of medical school.

It was an interesting year overall, one of the greatest periods of growth in my life. The year begun with Internal Medicine which was three months of what can best be described as intense investigative work. The diagnosis, to be sure, was generally known to residents by the time the patient came up to the medicine floors from the emergency department. However, the student was required to work things out himself and from the often varied history elicited from the patient and the carte blanche physical exam of a beginning third year medical student, he was expected to formulate differential diagnoses and gather information to rule them out or in.

After extensive literature review, pimping (aggressive questioning) by resident and possibly senior resident, and for the lucky like myself, a lot of teaching, one was usually ready to nail the presentation and answer the questions to follow from attending physicians. This was what could be considered good reward for 5-page scholarly medical notes and 30 plus hours spent in the hospital often with little sleep every four days. But sometimes, things were not so rosy. Sometimes, you got lost in the details and stumbled through tedious notes that did little justice to the work you put in. Those times, one could get discouraged but there were luckily few of these occasions.

Obstetrics/Gynecology, ObGyn for short, was my next gig, my first surgical experience as it was. The birthing process was awe-inspiring and much more violent/terrifying than I had anticipated. It was a rather weird experience, not the most pleasant. Getting the privilege of delivering twins increased my appreciation of the pain my mother went through delivering my big-headed brother and sister twins with no pain control. But those crazy mothers were always so happy when they saw the babies and swearing to have others. I decided then never to get a woman pregnant.

I intend to become a cardiac surgeon so it was the surgical aspects of ObGyn that really appealed to me. Typically, the life of the third year medical student involved standing silently for hours on end, sometimes scrubbed which meant you could not even scratch an itch, watching the laparoscopic screen. It was mind-numbing at times but one lived to put a stitch through the skin and throw a few knots at the end of everything and if a harried pace made that impossible, it felt like someone had robbed one of his very soul.

Pediatrics rounded out the half year and is a memory better forgotten. I loved it, I did and I absolutely loved the little kids as well. But the one thing it came to show me was the need for self evaluation and the politics of the hospital and grading policies. It seemed the nature of the pediatricians I worked with was non-confrontational and accommodating, which was in line with the work they do and made them very good doctors. But this was not always the best environment for the student because what it fostered was a situation where students could not get the most straight forward feedback when they elicited it. You could thus find yourself doing the same things and garnering praise for them only to end up with rather lukewarm written evaluations which allowed people to say things they could not tell you in person. If nothing at all, it was an experience that would change my approach to third year and for the better, I’d argue. It also showed me my need for honest feedback, good or bad from working colleagues in my future practice.

In my next piece, I will tell you about neurology, touch briefly on psychiatry and radiology and a closer look into the workings of surgery. Ask me questions about the more details you would like to know and if the HIPAA laws allow it, I will let you know.

Prime

*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************

"You Speak Such Good English" – Ten Things You Now Know About Ghana And The Ghanaian

Two weeks before I was to embark on my first trip to the US, I finally went to an internet café to find out exactly where the state of Ohio was on the map. I was to spend the next four years in Oberlin College, Oberlin, OH where I had applied and being accepted for a Bachelor of Arts program but I had no idea where it actually was. Thus when people have asked me whether I am from Africa, I often wonder if I should give them an education, offer a blunt reply or just plain ignore them. Of course I went on the internet to do my research and so could everyone else but I only did it because I needed to. So instead of a ranting piece on the lack of curiosity about the world that is exhibited by many an American, I will just go ahead and give a Ghana 101 from my perspective with the hope that someone reading this piece even by accident can help spare me a few awkward moments.

1. My English is good, yes. This is because we actually speak and learn English – the Queen’s English, that is –comprehension, grammar and composition.

2. Just like you do not speak American, we do not speak Ghanese or African. There are at least 47 different languages spoken in Ghana alone.

3. Ghana is the country. Africa is a continent, not a country. I am Ghanaian, and African, just like you are American and North American (North America, by the way, is a continent that includes Canada, Greenland, Bermuda among others).

4. No. I do not know your church member from South Africa. Enough said.

5. We live in houses in villages, towns and cities not in the bush living a primitive life in hunting/gathering tribes (apologies to random lady I met at Cleveland Cavalier’s game). In that vein, most of us first see wild life in the zoo either at home or in the US – cue student surprised to hear I saw my first elephant at a circus in New Haven and excited when I apologized and said we actually lived in huts carried by the elephants.

6. Football, as in the one kicked with the foot, not thrown all game long, is a Religion. It is to be worshiped and not derogatorily referred to as soccer.

7. No. I did not come to the US because there are no good schools in Ghana. Our educational system is screwed up, I agree, but they are not that bad. A lot of us come here for school because of the opportunities for training outside the classroom, the free education, and sometimes, because we could not get into the professional schools in Ghana e.g. medical schools.

8. Yes. My accent is sexy, I know, but your mentioning I have one is definitely not a turn-on.

9. Yes. I am a card carrying member of the LONG (League Of extraordinary Negro Gentlemen) but your knowing me is no guarantee of membership privileges.

10. And finally, I am grateful you volunteered in Ghana as a high schooler and you are welcome again. Your semester abroad, though, does not an expert make. Do not present yourself as an authority on the subject of Ghana.

To the Ghanaians out there, send me a comment on something you would like known about Ghana/the Ghanaian. To those who want to learn about us, send me a comment asking what you would like to know. Till then, cheerio.

Prime

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This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************

Une Idée

What did, the world, create
I asked my Lord
An Idea!, said He, not Fate.
And the Will to see it lored.

Prime

*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************

$2000 Roundtrip – Delta Airlines and the Ghanaian Traveler II

Thankfully, a bottle of water awaited each of us on the plane and throughout the flight, snacks were made available at the back of the plane—a unique experience if I may say so. Anyone who knows me of course knows I am probably pickier about my food than anything else and will thus not be surprised at my dismay at what presently happened. It was partly my fault because I requested the beef option, not being one who eats poultry but since I was met with some concoction of beef sauce, assorted veggies and white rice not becoming at all of someone who likes jollof, I promptly reconsidered my options and would have gone for the chicken option with jollof but Delta had run out of that option with many passengers still to be served. Next, I asked for apple juice and the flight had run out of that as well. Finally, on entering the US airspace in evening both destination and origin time, Delta served breakfast, with one unifying option of cheese and ham sandwich, a yogurt covered granola bar and a box of orange juice. I said a silent prayer for those hungry passengers on monoamine oxidase inhibitors (fermented cheese and some other foods can lead to a sympathetic crisis when ingested by someone using MAO-Is). I neither like cheese nor un-fried bacon so I was a little stuck there.

Of course I naturally expect airline food to be horrible and have been known to fly days on only water and apple juice because of this. However, more than the food, the manner in which stewardesses responded to my queries of “can I have this or that option” is the point of contention here and the reason for this entry. My questions were met with sharp and stiff “we don’t have anymore” and “that’s the only option” delivered in a devil-may-care tone. These were the things that grated on my senses. I can only imagine the stresses of being an Air Steward but that is no justification for displacement—taking it out on another. Having been on a Lufthansa flight with disastrous customer service between Accra and Frankfurt and impeccable service between Frankfurt and New York and having transited in other European cities, I am aware of the deplorable service provided by major carriers to and from Ghana and Delta has come in for a lot of flak on this point even necessitating a rebuke from the Transport Minister in Ghana. It seems that this has fallen on deaf ears. These airlines are indeed providing invaluable services to Ghanaians but they are in the SERVICE business and at over inflated prices given travel and demand over comparable distances, it is important that they recognize they are offering very little value for their money. In April of this year, I flew to and from Ghana on a British Airways flight which cost less than $1400 and was infinitely more comfortable with service rendered with deference not seen on Delta flights. I am a fickle flyer with little to no airline loyalty. While expanding the current number of days with direct flights to Accra from JFK, New York and adding an Atlanta line, Delta might do well to realize that in spite of our politicians running national airlines into the ground, there are other options and we will pursue them.

Write in and comment. Let me know what you experiences have been on other Delta flights to Ghana and the Western world. Are there any notable differences in service delivery? Happy New Year and may every one who wants water on a flight they have paid for, receive it with smiles.

PS: I have made it to Boston safely after missing my scheduled flight. And my bag is here with me as well though torn on one side. Transition from 27+C (81+F) to 1C (34F) is not helping my mood much. See you in another piece.

Prime

*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************

$2000 Roundtrip – Delta Airlines and the Ghanaian Traveler I

Plane ticket – 2000 dollars. Can of apple juice 55 cents. A little bit of customer service – Priceless. That is how a mastercard—themed commercial of the Delta Airlines direct flight between New York, JFK and Accra, Ghana would go. The last line, of course, would be sarcastic. During my entire sixteen days in Ghana over the past holidays, I have debated whether to write this piece. I am writing it now in the last hour of flight DL 167 from Accra to JFK expected to land within the next hour. Why? Ham sandwich.

But before we get there, let me tell you why after having experienced rather dismal customer service and the customary loss of baggage (they were eventually recovered) on my first transatlantic flight with Delta, I did it again. See I happen to be a student who had 14 days of break to spend over the Christmas holidays. My sister was getting married on the Saturday of the last weekend and I was expected back at work on Monday. As the plan stood originally, no matter how you slice and dice it, I could not be back in the US in convenient time on Sunday unless I was on a direct flight. Delta Airlines happens to offer that flight. My options thus limited, I cast my die with the transatlantic flight which in all the traveling I have done, still happens to be the only one on which the tv screens descend from the ceiling and the captain controls the 3 or 4 movies one watches (contrast with say British Airways where you have individual panels on seat backs).

It’s not all doom and gloom, however and there is still some light, however dim, at the end of the proverbial tunnel down which Delta seems to be flying. I had some stimulating conversations with a steward on my first flight with them and on this inbound flight, there was a particular gentleman, I made sure to get his name but have sadly forgotten it who was quite amiable, always ready with a smile and interested in the book I was reading – Invisible Man (A thumping good read and a work of genius). Alas that was blighted by the actions of his colleagues. Let me give you an example. Hardly had our flight left the ground after a long period of taxiing at the JFK than a lady sat in the row behind me pressed her call button. In comes the Delta stewardess in good time breathing fire:

Stewardess: What is your emergency?
Lady: I feel dehydrated. I need some water.
Stewardess: Is that an emergency?

Now forgive me for asking but were the call buttons actually put in by Delta only for emergencies? And even if they were, what constitutes an emergency? I am no authority on the issue but I do believe a lady who feels dehydrated, having been signaled ultimately by his body’s volume/sodium control would, depending on the situation, be rather treatable if caught early and if nothing at all, deserves some sympathy if not outright decorum from a stewardess in the service business. I have since spoken to my girlfriend, sister and other friends who came in on various other Delta operated flights and the immediate consensus is and I quote “OMG! The Delta Crew is so rude!”

Prime

*************************************************
This is the way I choose, the destiny I pursue
To help the unfit and the fit
To treat each according to his need
*************************************************