Random Synaptic Firings

[Above photo:  The tree-house-person drawing by a castrated boy. “The man is going to kill his dog because the dog has been killing the chickens.”]

8 October 2017

Try as I might, I cannot write these posts in a linear fashion, that is, with each entry themed. Sometimes, like today, it is just a random collection of events and reflections, cortical jumble. A more positive spin would be that I am confirming Piaget’s theory of learning: a step-wise progression from the energetic chaos of information-gathering to consolidation, repeated. Glad to think I am still learning. And that I can recall a bit of Piaget, even if perhaps erroneously, from 1977-78 in my Child and Adolescent Fellowship. Of course, long-term memory generally goes last. Now, what was I saying? Ah, yes, a perfect descriptor for our pres (there are so, so many, and so many opportunities he generously gives us!): an ignoranus. That is, a stupid ass-hole. I didn’t coin that, although I’ve appropriated it.

My second dinner party of last weekend was fun, like the first, although the cooking was not up to snuff. I asked Lucy about the onion-rosemary bread; Stefan said it looked wonderful. Lucy, truthfully, said it needed a bit more salt. I confessed I’d felt so successful and smart, making it all in a wok so the kitchen didn’t look like Ruthie’s Run at Aspen after a blizzard, that I forgot the salt and oil. Not bad but not as good as it could have been. And shall be in the future! As Harold’s patient at Neurology Institute in his third year clerkship said to him: “Good mornin’, darlin’ [doctor] Varmus. Every day I’m getting better and wetter and wetter.” Seconds before Stefan honked at the gate, I turned the burner underneath the risotto up to 4, a powerful setting for this range. Between 3 [tepid] and 4 [seventh circle of Hell] is an infinity. It is a Defy, from S. Africa. It does defy attempts to operate it with ease. After greeting them, I noticed a burning odor and smoke from the kitchen and realized the risotto was carbonizing. It was unsalvageable so I had to start again. Truth is, my second attempt was pretty darn good, considering I used sushi rice in place of Arborio, which I cannot find here. I’ll try it again, soon.

Mulanje is off-limits for Peace Corps and all Americans at present because of the violence over the “bloodsuckers”, so I won’t be going there this weekend   The shopkeepers, porters, guides, and pizza-joint owners should calm the people who keep the “bloodsucker” fire stoked, as the tourist trade has dried up. Apparently, rumors of vampire attacks are an old standard in Malawian culture, going back hundreds of years. Of course, it was the British then, and they were extracting what they could. We actually bring money into the economy, as well as expertise, friendship, good will, etc.

I saw a boy in clinic today who was castrated—penis and testicles—7 years ago (at 7yo) and brought to the ED at Queens with the story that he’d been in a motor vehicle accident. He had a few additional scrapes and bruises but no bits and pieces. The story didn’t ring true for the physicians on duty. Currently his uncle is supposedly suing the hospital for castrating his nephew. He’s been started on testosterone injections and is a handsome, bright lad with a tale which he will not currently reveal to anyone. He wisely was taken from his uncle’s custody during his initial hospitalization and is living in an undisclosed location. His mother died 4 months ago and he never knew his father. He drew the most amazingly revealing tree-house-person I’ve seen (above).  And has nightmares weekly of people “trying to kill me so I run away”.  It is almost beyond my comprehension and sadder than anything. Not sure where our therapy journey shall take us, of course, but I shall try to join him and see.  I thought the panga knife attack featured in last week’s blog or the numerous rapes I’ve heard about were the worst I’d see here. My vicarious traumatzation.

Having mentioned my trials at Road Traffic in obtaining the Certificate of Fitness for my car, I’m about to be re-immersed in the sweating, elbowing crowds there. Driving back to town from my consultation with a lively group of social work students and several journalism students at Samaritans, I was pulled over at a random police roadblock. After she examined the recent stickers I’d appended to my window (proof of insurance, COF), the officer asked to see my driver’s license. Slowly examining it she asked how long I’d been in Malawi. “Thirteen months”, I said. “That’s a 10,000 kwatcha fine, payable now. You must have a Malawi driver’s license (not one from Maine) after 3 months living here.” I hadn’t known that. I only had about 5,500 kawatcha ($8). “That’s not enough.” When it was clear I didn’t have the cash, I jokingly said, “What, will you put a professor at the College of Medicine in jail?” Smart ass—-stupid, actually, to mess with the po-po. I gave her 2000MWK, she gave me my license back, and I drove on. I hate to enter so directly into the system of corruption. I must return to Road Traffic next week and “start the process”, as she ominously said. I’ve emailed the US Embassy to ascertain the accuracy of her information.

This week I had to order 3 MRI’s. One for the panga knife attack youth who continues to suffer from daily headaches (He had a subdural hematoma.), one for a 68yo man with a 45year history of daily cannabis use who is wandering aimlessly around a dangerous area [Ndirande] every night and is confused, and one for an elderly woman who is ataxic and increasingly forgetful.  The procedure is worth explicating. I fill out a request form, get my head of department to sign his approval, and take it to the Hospital Director’s secretary, leaving it for a few hours for the Director to sign. [On one of them I had inadvertently neglected to fill in any clinical information. The Hospital Director signed it without question, confirming my suspicion that this is just a pro-forma approval.] Then I retrieve it and walk it over to MRI and arrange for the appointment. Back to clinic to put a top-up on the phone so one of the nurses can call the patient who generally only speaks Chichewa, notifying them of the appointment. Then I must remember a day or two after the appointment to walk to MRI, again, and give them my email address (even though it is requested and written on the form) so they will send me the result. Then I have to arrange for someone to read it, usually in Washington DC or Boston, as we don’t have a regular radiologist here to do it. [Some radiologists aren’t qualified to read them, let alone a child psychiatrist.] Then I must schedule an appointment to see the patient and guardian to share the results. Times 3 for me this week. And the distances aren’t negligible. Queens is a huge hospital, all on the ground level with large courtyards between buildings and very long corridors connecting the latter. The administration building is about as far from the MRI building as you can get on this “campus”, both on opposite edges of the periphery; Room 6, where I work, is midway. Pretty inefficient.

I have a weekend with no social obligations—I’ve been given two invitations but since I thought I’d be out of town I declined each and haven’t renewed—–or work demands.  I managed to get 4 new Pirelli radials on the car yesterday in a miracle of efficiency at the Indian-owned Mapeto Tyre Company, a big slick operation where the tyre installation, balance, and alignment are included in the tyre price. This is noteworthy, as added charges are a staple here; my bank charged me about $15 to deposit $10,000 from which they made money until I used it to buy a car. A spotless shiny white and black Range Rover drove in while I was there. The license plate was “M 1”, the designation of the main north-south highway in Malawi. I assumed it was a legislator. No, no, it is the owner of the company. Would you like to meet him? Sure. We shake hands. He is genial, and why shouldn’t he be; I just dropped 370,000MWK at his shop!  I did talk at length with a young Irish teacher from County Galway who was also getting tyres for his x-trail. He showed me a cardboard box into which he has installed a tiny battery-powered incredibly bright LED projector, with speakers, amplifier, a large lithium battery, solar charge controller, etc. It is a prototype for primary schools as there are various curricula in Chichewa on the net and it is much more efficient and economical to project them on a wall than to buy textbooks for a class of 90. He even had a metal lunchbox fabricated for him in the village into which he’ll fit all the components, protecting it from the elements and making it easy to transport.  Plus the aesthetics.  It all weighs about 15#. Ingenuity!

The guards are seemingly happy and showing up for work regularly. Cabbage had a sore jaw last night and I examined it with a spoon and flashlight. Through broken English and Chichewa I learned that he’d had an extraction two days before and had run out of “prufen”. I have a good supply of ibuprofen from Peace Corps and cannot use it because my kidneys were whacked by my first round of chemotherapy in 2008 so I gave him a several day supply and shall follow the infection. He has a couple of small, hard lymph nodes in the area but no real rubor, turgor, or calor so I think he doesn’t need antibiotics. It’s fun to be a doctor!

I’ve been sleeping very poorly, awakening and reading every two hours or so until I fade out again. I wonder, am curious, and worry about my children—where they are, how they are, who they are becoming. Finally, yesterday morning I wrote to my therapist in Berkeley about it and slept soundly last night. Amazing how effective sharing your stuff is! It’s one of the background themes I stress again and again with the medical students: how much suffering they can ease if they just listen.  When I was working as a Family Physician a young woman tearfully confessed to me that she’d slept with someone after a drunken party while her husband was overseas in the military. Talking about it greatly relieved her and when he returned several months later, she brought him in and they both thanked me for helping her. I doubt that she filled him in on the details, kindly.

The birds are returning and the birdsong is deafening. I am regularly seeing white-browed robin chats. Yesterday I saw a cluster of three mousebirds—they are large and crested, which makes them always look surprised. And their landings are hilarious, crashing into the bushes, making them sway wildly. And a dark-capped bulbul with his bright yellow vent. I’m awaiting the sunbirds, those tiny, brilliantly colored migrants. No roundups and deportations here. Oh, I just saw a blue waxbill at the birdbath, my first in 4 or 5 months. Now, how to get the house sparrows, those very chatty year round little eave-dwellers, from pooping on the wicker couch cushions on the front porch? A diet of rice and cheese? Imodium?

Linda is at her Peace Corps cohort reunion in Savannah, Georgia, birthplace of the martini. I wish I could join them. It is good for me to be alone but I miss her.

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