Keep it Simple

Back in 1998, I heard a trauma surgeon talk about communicating with patients. His words have stayed with me all these years.
The gist of his message was:
Physicians are as a group, are highly educated. A lot of the patients we deal with do not understand medicine, surgery, anatomy or physiology like we do. If we need to explain a procedure, the need for it or a disease process to a patient, we need to keep it simple.
Now that coming from a surgeon is deep!
It’s one of those things I’ve never forgotten. To keep it simple.
One can tell a patient:
“I am going to place a central line in your right internal jugular, float a pulmonary artery catheter and also place an arterial line in your left radial artery. You need that for your aortic valve replacement.”
Or one can say:
“To better take care of you during your operation, I need to place a larger iv in that vein in the right side of your neck. It helps us give you blood faster if you need it. Also, we feed a tube through it into your heart that helps us measure how much blood is being pumped in an out. You also need a better way of measuring your blood pressure. Feel your left wrist. Feel that pulse? That is an artery. I’ll put a small tube in there that will help measure your blood pressure better.”
Sure, the latter takes longer but you don’t have a patient who stares at you after you are done speaking like you just dropped from Pluto! We must all try to talk to patients in terms that are understandable to them. Terms that we take for granted may sound like Greek to most lay people. Even a term as simple as “colonoscopy” has befuddled some patients.
Some steps that can help me are:
I imagine explaining a procedure or even a disease process to one of my older uncles or aunties or to my kids. I break it down to a level they can understand.
I use diagrams that I sketch. I find drawing out the anatomy and pointing structures out and what is going to be done helps immensely. A lot of patients in Kentucky believe epidurals are the number one cause of paralysis in the world. A small drawing of the layers a needle goes through to reach the epidural space and it’s relatinship to the spinal cord helps immensely to allay some fears.
I encourage questions. If a patient can repeat what you said and base a question on that, your work is done.
Do not look at patients with disdain. It is not their fault that they do not understand what a myxomatous mitral valve is. I bet you do not know what Capital Structure Theory is either. A degree of empathy is needed to understand where patients are coming from. Without that empathy, it is difficult to relate to the patients and explain things to them at a level that is understandable.

Is it really that hard

Once upon a time, a white, middle-aged man was having major surgery at a University Hospital somewhere in the US. The surgery’s nature was such that, he needed the care of two anesthesia providers. On call for the procedure of that nature were two brown-skinned anesthesiologists. Let’s call them Anesthesiologist A and B (AA and AB).
When AA and AB met the patient prior to surgery, he appeared nervous and uneasy and they attributed it to anxiety. Who wouldn’t be nervous before such a big operation? AA asked a nurse to give the patient an anxiolytic.
They saw the patient again about thirty minutes later in the operating room. He was already on the table. While AA got stuff together to place invasive lines, AB exposed the patients upper arms and torso to place external monitors. The sight that met his eyes took him aback. The patient’s upper chest and arms were covered with tattoos. That was not the problem. It was what the tattoos said that rattled him. They were signs, symbols and abbreviations from a rather dark part of this country’s and European history. AB pointed to an abbreviation on the patient’s left shoulder. It was made up of a letter, repeated three times. Even though AB knew what it meant, without knowing why, he asked the patient:
“What do those letters mean?”
“The patient at this point had gone pale and had a sheepish, frightened look on his face. He muttered:
“I was young and stupid then”.
“Is it like a secret fraternity? Can I join?”, AB probed.
There was no answer from the patient. An uneasy silence filled the room.
At this point AA came over, having noticed the tattoos and the exchange. He stood close to the patient on the left side and smiled at the patient.
AB broke the silence:
“I guess it must be really secret. Don’t worry, we will take good care of you.”
And take care of him they did.
The patient did well during the surgery and was taken to the intensive care unit afterwards. About ten days later, he left the hospital for rehab.
What is the point of this rather true narrative?
If two doctors could bring themselves to take care of a man, who probably hates them for the color of their skin and in other circumstances would do them harm, giving him world-class anesthetic care for a complex operation,
HOW HARD IS IT TO BAKE A CAKE OR EVEN MAKE A BOUQUET FOR TWO PEOPLE OF THE SAME SEX WHO WANT TO SHARE THE REST OF THEIR LIVES TOGETHER?
A CAKE? A BOUQUET?
Think about it!

The Web

Humans can also create them….just not only those creepy crawlies!…one can create one of love, of friendship, of support…or one of lies, of deceit, of pain…yeah, one can….one can always create…

“A Web”
(A Platinum-Palladium print)

Story Time with Jooma

“The universe is made up of stories not atoms”.
– Muriel Rukeyser from “The Speed of Darkness”

She would shuffle in every evening as the sun set, stooped over her old, trusted cane. Her old, haggard body harbored an indomitable spirit, the fire of which lit up in her eyes. To a five-year-old, she was the oldest person in the world.
As she moved slowly across the courtyard, eager eyes would follow her.
She would head for her stool set in the corner of the courtyard like a throne. The dancing flames of the kerosene lamps that lit the courtyard always cast ghostlike shadows on the walls, enhancing the moment in intrigue and suspense.
The minute she sat down, three generations of descendants would form an arc around her stool. She would always cast her gaze over the assembly, as if to make sure no one was missing.
We always sat in suspense, riveted and waiting for the opening lines. We never knew where Storytime with Great-Grandma Jooma would head out to. It could be into the world of Kweku Ananse, about great kings and queens, a fable, an event from long ago or trips over hills and far away. We just waited and knew it would be good.
And then she would clear her throat and go:
“Kwezi wo dze ndze oo!”
And we would respond:
“Wo gye dze wo ara!”
Then even as the red flames of the lamps danced in her eyes, they’ll open up to usher us into her universe. Her universe of stories. Soon it became my universe too.
Over the years, I may have travelled the world, learnt the secrets of science and even marvelled at the stars and planets but at heart, my universe is made of stories not atoms.

Sprouting

It’s a cycle…as some die, others are born…as one takes the last breath, somewhere else a mother hears the first cry…as some are withering, others are…

“Sprouting”
A Wet plate collodion image

The Reflection

In the fading glow of the setting sun, he watched as it appeared on the shimmering surface of the lake….the contours, lines, and curves ….the tones thrown off by the ever-undulating ripples…

“The Reflection”

 

An Audience with the Father

After several months of pleading, I was granted an audience. I don’t even know how I got there but all of sudden, I found myself before this large, rather ornate gate. As I looked around, the gate opened as if by remote control. The mansion that was revealed was breath-taking. It arose from the carefully manicured grounds like a symphony from an orchestra.
I walked along the only pathway visible. It was marble! As I walked, I marveled at the landscaping. How expensive it must be to keep that, I thought. The pathway brought me to a massive wooden door. Just as I was about to open it, it swung open. Standing in the doorway was an old man with flowing white hair and a white beard. He beckoned me in. He introduced himself as Peter and asked me to follow him.
Words cannot describe the beauty of the decorations, paintings and statues that graced the mansion. Soon we came to another door and this one opened by itself too. It revealed a large hall. At one end sat a throne.
Peter turned to me and said, “He will be out soon. Sit in that chair and wait. Once he appears, you have thirty minutes. Good luck.”
He turned and walked off even as the door swung shut behind him.
Then I heard a voice go, “Nanadadzie my son, how can I help you?”
I spun around to see an imposing figure sitting in the throne.
Somehow, around him was a certain glow. His face was lit by a broad smile that illuminated the lines of wisdom that gave his face such depth of character. His eyes were deep and seemed to hold a lot of something. I couldn’t put my finger on it.
“Nanadadzie, you have 30 minutes. Use that time well”, he continued.
“Are you God?”, I asked.
“The One and Only”, he answered.
“Where is Allah? I wanted to meet both of you”, I asked.
“I am One and the Same”, he pointed out.
“May I call you just God or Dear God”, I asked.
“Call me Father”, he said.
“Father, do you know the mess going on down there on Earth in your name?”, I asked.
“I know, Nana, I know. It’s OK to call you Nana, right? Most people call you that”, he said.
“Of course you can, Father”, I answered. “So you know there’s a lot of bad things being done in your name and you are fine with that?”, I continued, incredulous.
“Nana, they use my name in vain to do these bad things”, he answered.
“So why do you allow that?”, I asked.
“You humans have free will, you know that right?”, he asked me.
“Father, free will to use your name for the Crusades? The numerous European religious wars? Slavery? Apartheid? Al-Queda? ISIS?”, I asked.
“Nana, the human ultimately has to discover the Truth”, he said.
“But, but the carnage is great. Did you see Brussels? And Paris? Have you seen what Boko Haram is doing in Nigeria? The attacks in Mali, Bukina and Cote d’Ivoire? The beheadings in Syria? Syria? Iraq? 9-11? What truth do you find from such carnage? That religion leads to violence?”, I asked, my voice rising.
“Nana my son, I could with a stroke of my finger, wipe all out. What lesson would that teach mankind?”, he asked.
“That you cannot mess with God. You did that back in the day!”, I volunteered.
“I might have but did it teach mankind anything?”, he asked, looking at me sternly.
“So we have to go through all this pain to learn? To learn what?”, I asked.
“To learn to live together as one”, he replied.
“Father, call me cynical but that isn’t happening. The Church you left down there is in shambles. You heard of all those priests and the kids, right? That was a disaster. Islam has been hijacked. The races hate each other. There are wars everywhere. Large swaths of the population is starving or dying from diseases. And we are supposed to live together as one? I’m sorry but I have no faith that will ever happen”, I declared.
“Nana, do you believe in me?”, he asked.
“Father, to be honest, there are lots of times that I have my doubts”, I offered.
“Nana, you are bound by time and space. I see eternity. Good always overcomes evil. The right shall dominate the wrong”, he said.
“You sound like my late dad. By the way, is he around?”, I asked.
“Yes he is but he is not the reason you are here”, he replied then continued:
“There is always a dark side to light. A bitter side to the sweet. Those who use my name for evil are the dark side of light. Ultimately, the light shines so bright, the darkness is unseen and unheard. Believe and be strong”, he said.
Suddenly, I heard a sound behind me. I turned to see Peter in the doorway.
“It is time”, he said.
I swung around to ask God a last question but the throne was empty.
I sighed and walked out of the hall behind Peter. With each step, I heard a ringing sound. As we neared the main door, it got louder. The minute he opened the main door, the piercing scream of my alarm broke through, waking me up to another morning of life on this Earth with it’s violence, pain and hopelessness. Or is all that leading to a time of peace, love and hope?
That is when it hit me. What I had seen in his eyes. His eyes were full of certainty. Certainty that all will be well. That good will overcome evil. That the right will dominate the wrong. Certainty.
I sat at the edge of my bed and realized that I wasn’t so certain. That good will overcome evil. That the right will dominate. I wasn’t at all but wished I had faith. Wished I believed. I didn’t.
I sighed.

The Healing of a Nation

“That is not a drug, it’s a leaf.”
– Arnold Schwarzenegger

In the next few years, two of the many areas that could be interesting areas of medical research and therapy may be the the fields of cancer immunotherapy and the medical use of cannabinoids. Yes, cannabinoids – those extracts from cannabis aka marijuana aka weed!

No other plant is as controversial as Cannabis. In spite of an almost 5000 year-old history of use around the world, it has been a banned substance in most countries in the last 100 years or so.

It’s ill-repute stems from it’s psychoactive effects which can be significant.
Some of the chemicals inherent in the most common species of this plant, Cannabis sativa, have been isolated and they are called cannabinoids. There are about 85 of them. The two most researched are:

– Delta-9 Tetrahydrocannabinol (THC) and
– Cannabinol (CBD)

Whereas THC is responsible for most of the psychoactive effects (the high), CBD has none of the high effect. Both cannabinoids have some very significant therapeutic effects.

THC – analgesic, anti-spasmodic, anti-tremor, anti-inflammatory, appetite stimulant and anti-emetic
CBD – anti-inflammatory, anti-convulsant, anti-psychotic, anti-oxidant, neuroprotective and immunomodulatory effects

Even more interesting is that the human body has cannabinoid receptors. This has been an area of research for the last 20 years or so. Two types of cannabinoid receptors have been found so far – CB1 and CB2. CB1 receptors are present in the brain and spinal cord and in certain peripheral tissues. CB2 receptors are expressed primarily in immune tissues.
Now if the body has cannabinoid receptors, then humans must produce natural cannabinoids. At least 3 have been isolated so far – arachidonoyl-ethanolamide (anandamide), 2-arachidonoyl glycerol (2-AG) and arachidonyl glyceryl ether (noladin ether).

These endocannabinoids are involved in areas of the brain responsible for:
– movement and postural control, pain and sensory perception, memory, cognition, emotion,
control and reward centers in the brain (limbic system and hypothalamus)
– cytokine release from immune cells and immune cell migration

So when one uses marijuana, do the cannabinoids from the weed react with the natural receptors? That is the thought and that is how they exert their action.

The push is then for strains of Cannabis high in CBD to capture the medicinal sans psychoactive effects. This is achieved by altering the genome of the cannabis plant to get strains that contain mostly CBD. An example of a strain with high levels of CBD is Charlotte’s Web.

In the forefront for drugs made out of CBD is GW Pharma, a company out of the London, UK. They have a drug out named Epidiolex for Dravet Syndrom. This a condition marked by intractable seizures in kids. These kids can have over 20 seizure a month. It reduced the incidence of seizures in a study of 120 children by close to 40%. FDA approval is pending.

CBD-based drugs are also being studied for Multiple Sclerosis. It reduces the incidence and severity of muscle and bladder spasms as well as the intensity of neuropathic pain.
CBD has been shown to reduce the incidence of psychosis in Schizophrenics and may modulate symptoms of fear in patients with PTSD.
CBD has been shown to be very effective in the treatment of chronic pain with a much safer safety profile than opioids.
There are a few studies out showing the cytotoxic effects of CBD on breast cancer cells.

All these examples are but a few of the therapeutic possibilities being researched actively.

CBD however still remains a Schedule I substance and thus viewed as illicit when used without a prescription or in a state where the use of marijuana is not legal.

Maybe Bob Marley was right after all:
“Herb is the healing of a nation, alcohol is the destruction.”