MICROBE II

The warm sunshine struggled through the heavy fog that hang above the town. The morning seemed calm and quiet, such that one would be led to believe that all was well with the world. From a red Corrado that had just sped into the hospital’s parking lot, emerged a man. It was 7.00 am. The engine was kept running, and with small, laboured steps, the man lumbered towards the main gate. The driver of the car, a young man in his twenties, kept a sharp eye on him.

          For a short while, the man wandered about the entrance of the institution. It was as if he had the irresolution of a shy boy who, doubtful of his reception, dared not accost a beautiful girl standing nearby. His face was drooping with despair, and beads of sweat started to gather on his nose. He fidgeted constantly, shifting his weight from foot to foot. He turned this way and that way, and spun his head left and right, throwing glances intermittently at the man watching him from the car. If one were to look at him for merely a short while, a certain unnatural, demonic dance would become manifest, emerging seemingly not by the instruction of the man himself, but by strange forces that stirred within him. 

The road in front of the hospital was deserted that Saturday morning, save for the lone wanderers who were walking back from their dens of sin. Two girls waddled past, giggling as they exchanged secrets that weren’t their own. In the typical city fashion, one of them was using a toothpick as a convenient alternative to a fork, feeding hungrily from a black paper-bag. The other held an equally unappealing vessel in her hand, from which she consumed what looked like an assortment of roots, leaves and twigs that are characteristic of the modern vegan diet. They both sauntered past, completely unaware of the man who stood a few strides away, at the precipice of death.  A matronly receptionist, on spotting the man from afar, beckoned and ushered him in. With a cold bow, he walked in. On seeing the man enter the building, the Corrado’s young driver stepped onto the peddle with a firm foot. The 3.2-liter VR6 engine roared loud and proud and barreled away at top speed,  leaving behind a cloud of dust. The old man didn’t bother to look behind him, for such a feat could only be accomplished with great difficulty.

“How can I help you, sir?” came the sweet feminine voice of the receptionist.

“I have….The doctor…is he in?” the man stammered.

With a calm smile, the lady cocked her head slightly gave him a nod. With a manicured finger, she pointed to her right. Stenciled into the frosted wire-embedded glass of the door’s transom window, were the words: Consultation Room 1. Without a word, he coughed deeply and teetered towards the door.

* * * *
The autopsy room was cold and dark, save for a flickering incandescent bulb that lit its mid-section. The carnelian coloured floors reminded him of the decades of stains that had now concealed the floor’s natural concrete hue, due to the abundance of blood, pus and other putrid fluids that ooze from the orifices of and incisions on the human body, and by the years of neglect by the hospital cleaners who were too terrified to venture into the pathologist’s territory. Dozens of morgue coffins were slotted into the walls and in the air hung the harsh smell of death. The autopsy tables littered about reminded him of the transience of life and the finality of death, but to philosophize was not why he had come here. The fetid fumes of formalin stung and made his eyes start to wet. With the cuff of his shirt, he dabbed them dry and cast his eyes into the inner section of the room.
An old man of about 70 years was sitting at lone table, pen in hand, scribbling away fiercely as if he had been possessed by a powerful idea, undisturbed by the visitor who having walked not so silently across the room now hoovered behind him. The old man’s garb was somewhat bland and boring, faded at the cuffs and collars by years of use. His gray beard and silver hair gave him the stereotyped look of a man who, having long lived, now possessed all the wisdom of the world. Indeed, his old, dark, expressionless face was aglow with an aura of distinct sapience, such that it could be deduced instantly when one looked at him that he possessed a mind that had meditated deeply on the mysteries of life, and witnessed with intimate attention the processes of death.
In his inquest, the old man always believed, a medical examiner must appreciate the complexity of the task at hand. In the grand orchestra of biochemical reactions that animate the human being, any molecule of any cell can malfunction. And as is the nature of an infirmity to effect more infirmities, one defect can soon beget another, and soon ensues a complex cascade of disease that quickly sets in motion the course of death.
To cure an illness, one does not always need to understand it: one needs to merely administer the cure, even if by accident. However, without knowledge of the classical course and the variant novel forms in which a disease may manifest, it is impossible to determine a man’s cause of death. What a difficult thing then, it must be, to be a pathologist.
Looking over the old man’s shoulder, the doctors was arrested by the elegant handwriting and the red ink that his pen so generously spewed. The doctor’s eyes began to run quickly across the text:

“JAMES KEEN AUTOPSY REPORT”
Kakamega County Pathologist-in-Chief

Prof. Oloo Oloo

Vitina Street, Otiende…

…

Case No: 0X.05.2022…

…

…

Cause of Death: Fatal Primary Amoebic Meningoencephalitis
Manner of Death:…acute fulminant infection…diagnosed premoterm in an immunocompetent middleaged causasian male…Kenyan resident…

The doctor skimmed silently through the page. His most peculiar patient of recent times, Mr. James Keen, was being immortalized in an autopsy report. The details of his final moments of life were being laid bare for all to see, by a man who never even knew him.

…he swam in ‘wellness’ spa contaminated by a parasitic…

…

...there is evidence of general brain inflamation…numerous infarctive effects found…

…

…bilaterally symmetrical lesions…

…gliosis…

“This creature destroyed his brain,” the doctor thought. The pathologist, despite his age, had systematically outlined all the details in a clear, sharp academic style.
…hyperacute clinical course…patient displayed uncharacteristic and unrelenting signs and symptoms…

“Yeah, I have never seen anything like it before…” he wondered, “not once in over 30 years.”

 

...diffuse and multiple foci of hemorrhagic necrosis seen…

…

…lumbar puncture had shown yellow-cloudy CSF…

..

…amoebic trophozoites present seen, ~50,000 trophozoites per microlitre of cerebrospinal fluid…
…rRNA gene was amplified by using primers…

…genotype was determined by sequence comparison with published data…

 …polymerase chain reaction analysis revealed a new pathogen:

Naegleria fowleri, 

Serotype X.

“Gene sequencing? When? We don’t have that kind of tech in this hospital. He must have sent a sample to Nairobi without my knowledge, and now he’s stumbled onto a new strain… lucky bastard.”

 

…This case is also the first diagnosed occurrence of PAM in Kenya!

…

…the physician possessed no knowledge of effective therapeutic options…

“What!” the doctor gasped in the confines of his head. “He’s going to say that there’s nothing I could do to save my patient!”
The doctor, stirred into anger, now started to growl, breathing hard. The warm, tickling sensation of breath at the back of the old pathologist’s head startled him. On seeing the large frame of a man behind him, he jumped in surprise and spun around.
“I could save him, and you know it,” barked the doctor, gliding to the front of the desk. Leaning onto it, he inched closer to the old man: this was a clear sign of aggression, the doctor wanted a fight.

“You could what?” sneered the old pathologist, folding his frail hands onto his chest.

“I could save him, just not here.”

“You think too highly of yourself, Daktari,” the old man continued. “The pathogen was eating his brain so fast that it started to rot even before he was dead. A mere Medical Officer could not save his life.”

“Oloo, just because you are higher in rank doesn’t mean you are better than me.”

“That’s exactly what it means, young man,” hissed the pathologist, running his pen through the edges of his beard. He was razzing him, and the doctor didn’t like it.
It was a petty intercourse between these two friends, who, exasperated by their own problems, were forced to seek a little excitement from annoying each other. The trivial fray that arose soon after, over who would use the dead man as the subject of a publication in a little-read journal, gave the doctor a small thrill. It reminding him of the days when he was a young delinquent, circling a newly acquired foe like a lion at the throes of a territorial battle. He smiled, albeit briefly, as his mind wandered off.
A few seconds later, slipping back into the present, he embarked on the matter that had brought him here.

“I want to see my patient’s brain.”

“James Keen, hmmm…Yes, cabinet 10. The photos are in the file. Here,” said the professor, handing over the spring file. In his meticulous style, Professor Oloo had photographed every cut, incision and dissection, arranging them in sequence, giving the reader the uncanny feeling that they were performing the autopsy themselves.

He had made a clean incision at the top of the posterior part of Mr. James head, peeling away the skin and exposing the parietal bone. This was followed by the peeling of the temporalis muscle on both sides of Mr. James’ temples with a sharp surgical blade, whet to a fine edge. The doctor’s mind wandered again briefly into his past, recalling his earliest years in the Kakamega School of Medicine. He remembered his first cut into a cadaver. It was a messy, jaggered slice produced by a trembling hand. At that time, it felt like he was committing a grave sin, and looking at a corpse always gave him that eerie feeling that arises when one constantly thinks about death. These days, however, he feels nothing.
The pathologist had subsequently used a bone saw to cut into the skull in neat arcs. With a chisel, the skull was prised open and removed, exposing the gray gyri of the brain. Pulling the brain slightly towards him with his fingers, he exposed the optic chiasma, which transmits what the eyes see to the brain. He cut it, and a few snips later, the brain was freed from its skull to be prepared for dissection. As the doctor immersed himself in the autopsy report, the door was suddenly flung open, and a heavy nurse burst in.
“Doctor,” Abby announced, “there’s someone in your office. In CR-1.”

*****

How susceptible a woman is to a man’s wanton displays of wealth! Whatever may be his age, his birth, his craft, his height, the asymmetry of his face, the colour of his hair or the diametre of his belly: there’s no vile vulgarian on this planet whose handicap in attracting women cannot be sufficiently compensated for by an abundance of wealth. Even if in his intellect there is a great deficience, and his speech is smirched by the misgivings of his native tongue, a deep pocket grants him great eloquence and genius, such that even the sharpest critic would be blind to all his faults.
A man, a gentle-man, is a work of art. He is what he possesses in the absence of wealth, and what he retains in the dark depths of adversity. He is his greatest faults and his gravest failures, and he earns his nobility by toil and skill rather than by right. He is the creations of his mind and he is the qualities that he acquires when he is driven by genius, passion, ambition and desire. These are the things that in various shades and forms make a man, but it must not be forgotten that to a woman, the canvas is of much less importance than the frame.
Therefore my fellow men, beware the gaze of a beautiful woman, especially that of Jane. She is neither timid nor shamefaced before a man, and by emitting her words in sonorous whispers, she can bring any of them to her will, painting their faces with shame. Like a child that dares not look at the sun, you must never let your eyes meet hers for longer than a brief moment. She is dangerous, and no one knows the limits of her powers better than the doctor.
The morning ward-round had just come to an end. Jane, also done with her morning duties, had come to the doctor’s office to keep him company while he nursed his favourite drink. He often preferred solitude to company when he wanted to think, but Jane was the kind of woman that he dared not despise. Unlike her peers’, hers was not the kind of beauty that a light rain could erase, and her brain was not the empty vessel – veiled in imported corpse hair – that other women often carried around.
She was a woman of some sharpness, and was a companion in whom his thoughts often found understanding. He could bounce any idea off her at any moment and receive as a ricochet a steady stream of sound speculations. She was also the kind of woman whose remarks often earned her the approval of intelligent men and the disdain of everyone else. That, he thought, was the finest character that a woman could possess. If he ever decided to marry, a most dreadful decision, she would be the kind of woman that he would marry. It is said that marriage has the power to display a woman’s faults and reveal her character, driving her to discard, one by one, the acts, artifices and crafts that she used to carefully conceal her true nature. Acuity, however, is not a quality that slow mind can imitate. An intelligent woman can be spotted from a far, for she glows as bright as the sun.
They sat in silence. The doctor, behind his desk, with lab coat slung over his shoulder. His hands were resting on the table, clasping onto a recently refilled glass of fine brandy. Jane, sitting on the table, twirled the doctor’s stethoscope delicately in her hand. She liked to tease him, watch him, toy with him. There was something about him that always filled her with wild fires and made her feel drawn to him. He was the kind of man, she thought, who could wipe her tears away faster than they could well, and soothe her sorrows quicker than they could swell.
The richness of his perfume intoxicated her, and drew her to him like a moth to a flame. She lowered her head and let her dark-brown eyes peer at him above the rim of her spectacles. On seeing the misery on the doctor’s face, a felonious grin came upon her luscious lips, and in a swift motion, she eased onto his lap. The thickly laid layer of gloss on her lips glimmered like a pearl in the warm light. Hers were lips that could cast a potent spell.

“What do you think is wrong with him,” she asked, almost in a whisper.

“With who?”

“Him, Kimani.”
After a moment of silence, came the doctor’s reply in a low groan, “Ah, I don’t know. Everything.”

She smiled, looking at him with curious eyes over her own glass. She swirled the amber liquid seductively as she examined him. It isn’t often that the doctor gets lost in the woods, but he had admitted that strange thoughts had been pursuing him since Mr. Kimani arrived. He knew that the cards were stacked against him.
“Why don’t you know? The tests were done, and the results are out. This one is simple, too diagnostically simple for you,” she whispered, running a finger along the edge of the doctor’s chin. She liked the rough texture of his beard, and let her hand linger for a few moments upon his skin. The doctor, so deep within the domains of his mind that the feminine charms of his visitor could not harm him, brought his glass to his lips. When a man can’t think, he must drink!

“I…I…I think we will lose this one….” he stuttered, letting his head rest upon the vixen’s breast. She trembled, but not in fear. For a second, she was motionless. Twas as if her heart stopped and her blood congealed within her veins. However, the feeling was short lived, for he raised his head to take another sip, and never let it fall back onto her chest again.
“You are the best doctor in the county,” she continued, planting a soft kiss onto his cheek. “If anyone can help him, it’s you.” 

Like one accustomed to greater praise, his remained motionless, unfazed, deep in thought.

“It’s too late,” he sighed, decanting into his glass the last drops that still clang onto the bottle.
Without disturbing him, she reached into her bag and drew out a familiar object.

“You need this,” she whispered.

The object, if its shape and hue were inadequate, announced its identity by its soft and earthy smell. For an instant, the doctor’s eyes seemed to come aglow, but he soon returned to his cheerless comportment.

“You brought weed here? Are you crazy?” he grumbled, trying to shove her away, but she would not be dislodged so easily from his lap.

“Yep,” she hissed, “and this one is good. Open the windows. You don’t need much, just a few puffs to stir your mind. Trust me…”
Some temptations cannot always be overcome. Long ago, while he was still in his formative years, this trusted medicant had been his source of catharsis. It was like a gift from the gods: muse, mate and tonic, all in one. He often tread on dangerous paths in order to acquire it, and remembered with fondness the pleasant moments that he had spent in the company of his campus mates, spaced out, hiding in a dark room in the slums, in fear of the money hungry police officers prowling about. Over the years, he recalled, he started purchasing larger quantities for his own use in order to make the dangerous walks fewer. He then altered the frequency of his indulgence, letting his habit morph into an exquisite preprandial ritual. After all, it made any meal taste so much better! When it kicks in, everything seems to acquire a finer quality, a deeper meaning. It lightens the dull world, garnishing every thought and every object with a sharpness that sobriety cannot supply.
Due to the strength of the medicant and its sopoforic effects, the doctor was soon fast sleep. The vixen planted a soft kiss on his lips, and having her own duties to perform, left the room quietly. He was still lounging on his chair when the knock came. Rubbing his eyes, he reached for his phone and checked the time. It was 00:14 a.m.

“Shit.” he mumbled. He had been out for over 8 hours. Sitting up soundlessly, he listened for a second knock, hoping that he had merely imagined the first one. At this hour, even cordial visits tend to be unwelcome, and telling by the loudness of the knock, this was definitely not a cordial visit. Unfortunately, it came, louder and more distinct, punctuated by the call that every physician dreads:  “Doctor!”

As he walked towards the male ward, it suddenly became clear why he had been so expressly summoned. The howls that came from within the ward struck him so much that they slowed his steps, and for a brief moment, he felt like he was welling with fear. Mr. Kimani, unable to bare the agonies of his disease, had curled into a little ball at the foot of his bed. His suffering had reduced him into a late-night spectacle, to be marveled upon by those who are too terrified or too unwilling to help.
There was no life in his eyes. He was frail, motionless, cadaverous… and to all who looked at him, it seemed that hardly a few nights would pass before he is claimed by death and by the pathologist. The distinct viciousness of the attack was merely the precursor to the organ failure that was bound to ensue. It seemed that the man, as a consequence of a dying immune system, was being plagued by multiple maladies at once. It was as if a hot liquid had been injected under his skin: it was blistered at multiple spots, squirting out a putrid yellow froth when only a little pressure was applied to it. The man had therefore lain on his side so that the blisters on his back and chest were not ruptured by the weight of his own body.  By the physical signs on his body that were gradually becoming manifest, it was clear that his suffering was going to be great. His face, if his cries had failed, revealed by its contortions that he had been caught in a vice of agony.
“What have you given him?” barked the doctor.

“Paracetamol, tramadol, Xpen-Genta, his first dose of HAART…” came the quick list from Brian, a clinical officer standing nearby. He had clasped the patient’s file loosely in his hand, displaying the treatment sheet to the doctor.

“Something is not right,” the doctor thought, “why is he not responding to the pain killers?”
“Mr. Kimani!” came the doctor’s voice, firm and stern. He had walked up to him, standing so close that the Kimani was barely an inch from his feet.

“Yes…doctor,” came the man’s response, frail and infirm.

“Did you take your medicine?”

No response.
A small crowd of young but battle-scarred clinicians and nurses had now assembled behind him. The other patients, desiring a better view, were now kneeling on their beds and craning their necks, while others tip toed silently around the crowd to better spots. This, they hoped, would be a memorable spectacle. “Give him hydromorphone 4 milligrams IV. Stat!”

In seconds, Brian had descended upon him. Folding back the sleeve of Kimani’s right hand, he revealed a network of large veins that crept up his muscular arm. Suddenly, a feeling of uneasiness came over him and the syringe shook vehemently in his hand. In the world of medicine, a singular error can quickly become fatal. Sadder still, such errors are not uncommon, and many who have sought after healing in the arms of a phisician have often found a quicker death. However, ten minutes later, by the power of the synthetic molecule, Mr. Kimani’s agonies had started to wane.

 

“Get up. Now, Mr. Kimani.”

As Mr. Kimani struggled to stand up, holding onto the doctor in order to steady himself, two white tablets fell from his trouser pocket. Just like that, the mystery was dispelled.

“Those were for the pain, you should have swallowed them.”

“No. No drugs. I know my God. My suffering is part of his plan,” came the man’s retort.

“Kimani, where are the rest of the pills?”

With a trembling hand, Mr. Kimani reached deep into his pocket and extracted an assortment of coloured pills that had now been dampened by his own sweat.

“Jane,” the doctor continued, “what should we do? The patient seems non-compliant. What do you think?”

Jane was standing a few strides behind him in the small crowd, holding an emergency tray in her hands. Although out of sight, her sweet perfume was unmistakable. She handed the tray over to the nurse standing behind her and stepped forward to the doctor’s call.

“I suggest we change his drugs from tablets to IV,” she said. “He’s too stubborn to swallow them anyway, why not just inject them into his veins?”

“Every patient has the right to refuse to take their medication, except when…oh, but yes, I.V. What about the ones that cannot be taken by IV?”

“Abby is in charge of the male ward. She will ensure that he swallows every last pill.”
Mr. Kimani had now sat on his bed. He cared not for the humans that had surrounded him. After every few moments, he would mutter silently under his breath and let out a deep sigh. He had the stoic resolute of a pious man, and he was proud of it.

“Your son called me when you came. It happens that he was once my student. Did you know that?”

“No,” answered Kimani, looking at the doctor dead in the eye.

“He told me a lot of things about you,” the doctor added, watching his patient closely.

“I don’t care.”

“He said that you can be a reasonable man, and that you can also be stubborn, which is why he brought you here, to me. He also said that you need a psychiatrist.”
There was a moment silence. No one coughed nor stirred, and for a brief instance, if you were keen enough, you could her the wheeze of an asthmatic patient standing a few beds away.

“Brian,” the doctor continued. “What do you think we should add to his treatment sheet?”

The clinician looked back at file in his hand.

“Amitriptyline,” he proclaimed.

“Amitrip? Why?” asked the doctor. He was now facing the crowd, looking straight at Brian.

“You know why,” Brian said with an air of finality. “100 milligrams, then we observe and see what happens.”
Turning to his patient, the doctor grinned. “You need treatment, Mr. Kimani. Do you want to die here, like this?”

“I’m not going to die.”

“Oh really, humour me,” the doctor teased. Sarcasm, aided by sound reason, is the sharpest blade.

“You don’t know everything, doctor,” he added, leaning on his small table and placing a partial fist under his chin to support his head. He then fixed his eyes onto the man that towered above him, and continued, “I know that look on your face. It is the look that one wears when he thinks that he is God.”

“One day, we will all be Gods,” came the doctor’s retort. “That is the destiny reserved for the men of science, if the powers they acquire do not become their own destruction. We are sworn to the natural light of reason, even though we are damned to be excoriated rather than celebrated by our fellow men.”
After a deep hacking cough, the patient’s response came.

“Men like you are going to burn in hell. The wisdom of man is foolishness to God, and…”

“And the wisdom of man is the only thing that can cure you, Mr. Kimani. After all, you walked past a number of churches to come here, didn’t you?”

The patient offered no response.

“And by the degree of your suffering, it seems that we were last on your list. You came here only because you realized that you were going to die. That wasn’t smart at all.”

“My son brought me here. We made a wager.”

“A foolish one. He told me everything about it, that his father would rather die than submit to medical treatment.”

“I don’t need your medicine. Many are the afflictions of the righteous, but the Lord delivers him out of them all.”

“Your son brought you here for me to heal you. You have waited for your god for far too long.”

“Only God can heal.”

“Then take this medicine and let’s see if man cannot.”
Finally lured into submission, Mr. Kimani complied. Brian quickly fixed a cannula into the man’s vein and started his first round of treatment. A short while afterwards, the crowd dispersed and the ward returned to its usual humdrum state. As the hours went on, the events of recent past began to fade. Hours turned into days, and soon, a week was coming to a close. Gradually, Mr. Kimani was growing stronger, in body and in faith.

 

Every one watched him for it was quite impossible to miss him. He snored loudly when he slept and woke up long after sunrise. Then he would yawn loudly, licking his lips and rubbing his belly as if he has just been extracted from a feast. He would then plant his feet onto the floor, and there they would lie for a good half-hour, until the battle was won between the necessity of getting up and the sweet delicious warmth of his bed. After having his breakfast, he would walk about in the crowded wards, reading his old bible to his fellow patients and offering summons to anyone who would care to listen. When the spirit of worship came upon him and struck the innermost chords of his heart, Mr. Kimani would break into song, and those that cared would join in. The treatment was working.
On the final day of his admission, the air was cold and the winds were crisp. Evening had quickly turned to night, and the hospital had fallen into a calm quietude, broken only by the barks and howls of creatures that roamed the night. Mr. Kimani, eager to be discharged the following day, had eaten to his fill and decided to go to sleep earlier than usual. A little after midnight, a heavy coughing fit came upon him, but it passed quickly. His laboured panting petered to peaceful breathing and all his miseries seemed to be washed away by the touch of a holy hand. He relaxed and lay still, sinking into silence.

 

Suddenly, in a series of kicks and shudders, his body began to jerk, shaking the bed into a soft bounce on the concrete floor. The man’s jaws, locked tightly by neural impulses running amock through his brain, could barely part to release a cry for help. The seizure bent his back into a deep curve as if a high current had been discharged into his spinal chord. To an observer, it was as if a rod had been shoved violently through the man’s back and was forcing its way out through his belly. A light rain had started to fall, and its dull ebb muffled the sounds that Mr. Kimani could force his lips to produce. The patients in the male ward slumbered on, undisturbed by the grand mal seizure unfolding within the room.  The man was fighting for his life, but not even the lightest sleeper lying next to him could be roused.