Lunatic Express nearly ruined my date with critical patient

Inspired by fellow novelist Peter Kimani who wrote in the Sunday Nation of May 28 about the train ride that shaped his destiny and the topicality of the subject, I wish to write about my unforgettable experience — when I travelled from Mombasa to Nairobi on the same train few years back.

Now that the “Lunatic Express” is receding into Kenya’s history after a run of over a century and the Standard Gauge Railway (SGR), arguably, the biggest infrastructure project in our country, has been inaugurated in its place, I think it is an opportune time to relate my unique experience that can only happen in Africa and which not many people can boast of.

A modified version of the story was first published on Madaraka Day in 1980 as the second story in the Surgeon’s Diary series on May 24, the same year. But the locale and timing of the event will withstand a “repeat performance.” Furthermore, I wonder how many of my loyal readers will remember the details and surely, a new generation of readers has emerged after 38 years and I am sure they will enjoy it. So for better or for worse, here we go!

It happened when the Safari Rally ran over the long Easter weekend. Our daughter, Jenny, who was at Loreto Convent and our son, a student at St Mary’s School next door, prevailed upon us to take them by overnight train to Mombasa, a great tourist attraction at the time for Easter. The train journey from Nairobi to Mombasa on Thursday night before Good Friday was enjoyable and uneventful. The train left the station  at 6.30pm.

As we settled in our four-bed cabin, two below and two bunk beds above for the children, we saw giraffes, zebras and warthogs as the train skirted the Nairobi National Park. The bedding arrived and soon the attendant went along the length of the train, ringing a bell inviting us for dinner. We walked to the restaurant car, which was filled by tourists and expatriates, enjoying their gin and tonic or our world famous Tusker. There was polished cutlery on the dining table.

We were served a delicious three-course meal with hot French onion soup, very tender Molo Lamb with mint sauce, roast potatoes, carrot, cauliflower and broccoli. For dessert, we had cream of caramel, followed by a variety of Kenya cheese and biscuits. dinner ended with home-grown tea or coffee, depending on preference.

The next morning a full English breakfast with bacon, eggs, tomato and sausages was served in the same restaurant car, after we had our ablutions with hot and cold running water and a wash-basin in our compartment. Some passengers managed to have a wet shave and properly suited to work straight from Mombasa Railway Station, where the train stopped exactly at 8am. Holiday makers like us were escorted to our hotels in transport provided by the hotels.

COSMETIC ROLE

We enjoyed the sea, sand and sun over Good Friday and the following Saturday, quite unaware of the medical drama taking place 600 kilometres away on Saturday evening. The safari cars were passing through Nakuru that year and a romantic young couple was watching them from their VolksWagon.

One of the service cars got into the safari mood and crashed into the stationary VW. The girl died on the spot and the boy sustained a fracture of his femur, thigh bone and was taken to Nakuru General Hospital, under the care of the late Mr D’Cunha, the provincial surgeon. He examined the patient, arranged an X-ray to confirm the diagnosis and put the fractured limb in Thomas’ splint with a view to nail the fracture after the holiday weekend.

On Sunday, on his normal round the Sister reported that overnight the boy was confused and slipped into coma. Initially Mr D’Cunha was puzzled but quickly got his bearing when he recalled my article in the medical journal.

His patient had developed fat embolism of which I had seen three cases and published them with my recommended treatment of this unusual complication.

Two of my patients had survived with the special treatment, considering the high mortality recorded. Fat embolism is a condition where fat from the bone marrow at the fracture site travels to the lungs, escapes the sieve of the pulmonary circulation, lodges in one of the arteries in the brain, blocks it and renders the patient unconscious.     

Mr D’Cunha obtained my contact in Mombasa from the Aga Khan Hospital in Nairobi and rang me on Sunday around lunch time at the hotel and said. “I think I have a patient with fat embolism and having recently read your article on the subject, I want him to have the benefit of your experience.” Then forestalling my question added. “There is no doubt about the diagnosis because chest X-ray shows fat lobules and his urine examination shows the same.”

I took a little time to think and replied. “I am returning home today on the overnight train and will be in Nairobi tomorrow, Easter Monday morning at 8am. Please send your patient to the Aga Khan Hospital and I will inform my Registrar to start him on our treatment.  As you know, these projects are driven by trainee surgeons and our role is mainly cosmetic!”

Our problems started at Voi Railway Station, where the train was inordinately delayed. I saw a lot of activity on the platform as I walked over to the station-master’s office to find out the reason as to why we were not moving. He was surrounded by passengers with the same question, but when I introduced myself as a surgeon, he gave me priority and candidly explained.

“The goods train before you knocked down an elephant which had strayed from Tsavo and its body is still lying on the tracks blocking it. We are mustering enough labour force to move it.”

“When will this happen?” I asked.

LORRY RIDE

“Your guess is as good as mine,” he said.

I explained it to Marie and waited for a couple of hours, at the end of which Marie looking at my anxious face said. “I can see you are worried about your patient. I suggest you walk to the main road and hitch a lift. The children and I will be fine.”

With that assurance and casting a glance at Jenny and Jan, fast asleep in their bunk beds, listening to the chirping birds at dawn on Easter Monday, I walked to the Mombasa-Nairobi Road. Little did I realise that at that hour, no motorist was going to stop and give a lift to an unshaven hitch-hiker in a crumpled cotton safari suit! After 18 cars passed ignoring my thumbs-up sign, I walked  to the nearest petrol station, hoping that a car will pull up there to fuel.

True enough a lorry drove in and I explained my predicament to the driver with an orphan’s expression. “Hop in the back,” he ordered. I could see that the passenger cabin was occupied by the turn-boy and a lady whose reputation I was not prepared to bet on!

In those days I was agile enough to jump in a medley of hessian bags filled with fertilisers as I heard the driver ask, “Where in Industrial Area can I drop you?”

“At Baring Biscuit Factory.” I replied hoping that my friend, the late Madatally Manji, the biscuit baron, will be there to help me with transport to the hospital. Thankfully, the lorry-driver also suffered from safari fever and landed me at my destination in three hours flat.  My workaholic friend was on his desk as usual and asked his driver to take me to the hospital in his Mercedes, a refreshing change from the back of a lorry!

I was met at the hospital by my Registrar, who proudly related to me that he had started the boy on our protocol of high pressure oxygen, intravenous anti-coagulants to dissolve the fat lobules and antibiotics to prevent infection.

As I was examining the patient and noticed that his oxygen saturation was inadequate, the trainee surgeon suggested. “I think he needs tracheostomy to improve his saturation.”

He meant a hole in the windpipe for the oxygen to flow directly to his lungs. We did that under local anaesthesia while the patient remained in his bed. After a worrying ten days, the boy gradually woke up, the first indication of his recovery being him finding the tracheostomy tube irritating and pushing it out.

A week later, he went home and in time, I published a review article, raising the survival rate in my series to three out of four!

I hope the SGR — goods and passenger version — has provision not to ever knock a Ndovu, who will continue to wander from the nearby Tsavo National Park!