The Mouth on Joseph

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A sink fell on a boy. You know boys. Maybe he was hanging on it like a monkey. It came off the wall and crashed into his face. The whole damn sink. Nine years old, with his milk teeth and all. He screamed in pain and terror. His mom ran into the bathroom, had one look at him and screamed. There was no blood yet, just mangled maxillofacial bones. [Look at me, using medical terms]. His face was a mess, like a prop in a horror movie. There were bone fragments lodged in places they didn’t belong and he was yet to get to the hospital for surgery. To save face. He was yet to meet doctors and nurses and surgeons who were currently having tea. 

There is a small room at Gertrude’s Children Hospital’s surgery wing, where the surgical staff gather to have tea and bitings. A sink, table, a few seats and a note that urges you to wash your shit once you are done. There are thermos flasks and sugar dishes and food wrapped in clear polythene on a table outside; eggs and sausages and bread and margarine. There is chatter, playful joshing and ribbing and laughter. Doesn’t matter if you have a PhD or you save lives; adults are generally children when there are no children around. 

I was in that room recently, adorned in scrubs, having tea and listening to banter that was oscillating between complicated medical jargon I didn’t understand and mindless banter. The sausage was miserable. Sausages are miserable in the cold, it’s like nibbling on a walrus’ toe. It was a particularly cold morning. Bitingly cold. My tits were freezing and I wasn’t allowed a sweater or a long t-shirt underneath my shirt. Policy. Rules. 

In another room, in another wing, a mother was cuddling her one year old son. The boy’s name is Joseph, like from the Bible. About one in 1,200 babies in Africa are born with a left cleft lip. Right cleft lips are very rare, but Joseph was born with one. An outlier amongst outliers. It’s not politically correct to say anything disparaging about babies because babies are God’s messengers on earth and they are innocent and they didn’t choose to be here. Plus they can’t defend themselves. But the truth is a cleft lip is not very sightly, much less on a baby. You can’t stare at it for too long without sighing and looking away. It looks like they were crawling under a fence and their lips got caught on a barbed wire and they started yelling and someone came and pulled them out, ripping their lips in the process. Then they were born. 

When Joseph was born and he was placed in his mom’s arms, she gasped a little in surprise. She had never seen anyone with a cleft lip before. These things didn’t happen to them. She thought, what’s happened to my son? Why are his lips like that? What did I do to God? Is this some sort of a curse? The doctors told her, ‘this is called a cleft lip. Happens to some children.’ They couldn’t answer many questions about it. Nobody knows what causes cleft lips. Maybe it’s genetics, or environment, smoking, illness, infections, whatever. Doctors don’t know, which is odd because if doctors don’t know then who will?  What they do know, though, is that Asians have more cleft lips than anybody else, and that it’s less prevalent in Africa than it is amongst white folk. But it’s more common in Machakos than in Nyanza or the coast. The Somali community particularly has it more than anybody else. “But the fact is that people who are really poor tend to have it more than any other social class,” a doctor told me.

Can it be fixed? She asked. The doctor said, ‘Yeah. It can. We know someone.’ That someone was Smile Train. They are a cleft-focused NGO that funds, trains and generally empowers medics to correct cleft lips. God’s work, in short. They are like a virtual choo-choo train that goes around the country, around the world really, billowing smoke and handing children smiles like confetti. Sometimes they throw smiles out the window when they can’t stop and children running after the train grab these smiles and wear them and go home and their moms ask, where did you get that smile and they say, from the train, mommy, the smile train, and suddenly the homes are filled with so much joy because nothing bad grows around the smile of a child. 

Anyway, I’m having terrible sausages in that room. 

Everybody has a sausage story, right? Allow me to quickly digress and tell you mine. In 2009, against my better judgement, I decided to take an assignment about scaling Mt Kenya. [If you’ve read that story before, just skip through the next two paragraphs]. Normally I’d not bother with these things because I come from the lake region. We don’t climb mountains, what are we, mountain goats? We get on boats. We fish. We bath naked by the lake. 

It was a big group; about twelve people. Mostly whites in sunglasses looking longingly up the summit. There were porters; lithe strong men. We spent a cold night in Naro Moru then set off in the morning. It was cold and miserable and it rained constantly. We kept our heads low and trudged. I got more and more miserable with each passing hour. We ate cold sandwiches during breaks. At night we set up camp. I had never slept in a tent before. I thought only serial killers who hitchhiked did that. Nights were insanely cold. The wind constantly howled and moaned outside the tent. Sometimes the tent flapped violently in the wind. Once in a while I’d hear a howling sound and wonder what kind of animal would be out there in that cold and darkness. In the morning I’d see mountain hyraxes skirting about. They looked like big rats. At camp, we ate bread and fruits and sausages. The sausages were cold and shrivelled. And because I constantly had a headache [altitude sickness] my taste buds were shot. I was sick and cold like a dog. At the summit, it was misty and drizzly and people were celebrating and taking pictures while I sat on a cold rock, defeated.  I found no joy, no triumph in summiting. I felt like a block of ice, shrivelled inside like those sausages. 

For close to five years after coming down the mountain I didn’t eat a single sausage. Every time I saw a sausage I got shivers. I looked away. Sausages reminded me of the misery that lives up that mountain. 

How I eat my sausages now is that I eat them first and eat them fast. 

Anyway, I washed my shit in the sink and went to read the notice board outside the theatre. The anesthesiologist showed up. Emily from Smile Train had earlier introduced him as Dr Bartuiyot Erick. Tall fellow with a tall bent shadow. And a hell of a manly name that, Bartuiyot. 

“I know you,” he said. “I have read your work.” I don’t know why I beamed. I didn’t think anesthesiologists had time to read blogs and things. Dr Bartuiyot, who puts people to sleep in the theatre, tells me about amnesia, hypnosis and muscle relaxation. He’s got a Masters in this stuff. He served in the army before; joined as captain, left as a Major. 

He’s 52, which is a great age to be as a man because you are already cemented and rooted in your person. You have had a few knocks in life but you no longer hide your scars. You have peaked in life, the turbulent weather your ally. You aren’t rattled easily. You don’t fear shadows you don’t recognise. I can tell Bartuiyot is there. He’s assured. We stood there shooting the breeze, waiting for Joseph. I asked him about the army, what he learnt. 

I asked him about death. “Have you seen the hand of God?” He told me war stories. People who defied medicine, people who came in with gunshot wounds, grisly road accident victims, barely having a pulse and a chance, who pulled through. Miraculously. “That’s not medicine,” he said, “that’s God.” I asked him if he thought people know when they are dying. He nodded and said there are people who know. There are people who have told him, if I go into that theatre, daktari, I won’t come out. And they didn’t. He shrugged as if to say, who knows about these worldly things, man, I just work here. Children are the hardest to lose. “I have four kids,” he said, “all teenagers.”

He told me about a night when he used to work at KNH’s ICU unit. “We lost 22 patients in a particular 24-hour shift; Heart attacks, road accidents, critical patients, cancer, we tried to save them but they were just dying one after another. Twenty two dead by the time my shift was ending!”

That changes you, right? He swayed on his hind heels like a dissuaded canoe, like a child. He’s very chatty, very amiable, mischievous even. “No it doesn’t, I wouldn’t say it changes you,” he said. “It’s life. It shocks you, yes, but it happens. Death is a part of this job. But so is life.” 

“So that day you just removed your scrubs and went home to your family, like nothing happened,” I said, “taking death home with you.”

He chuckled. He thought that was too melodramatic. [It was.] He wasn’t sold on the idea that stuff just changes one. What are you, putty? “You can’t take work home. You learn to dissociate the two. Otherwise you would not be able to try to save someone else.” 

He said he grew up in Uasin Gishu. I’ve never been, but it strikes me as a place with acacia trees and low-hanging clouds. 

A bespectacled man showed up. I could tell he was someone. He carried silent authority. Mild-mannered, gentle. Dr Bartuiyot said, “Huyu ni  Dr Tom Osundwa, the oral and maxillofacial surgeon,  lecturer at the University of Nairobi  and a prince in scrubs.” The reverent way he introduced him was befitting of a Game Of Thrones introduction; This is Tom of House Osundwa, First of his name, Prince in Scrubs, Ruler of maxillofacial Surgeons, Slayer of Cleft Palates, Protector of Children, The Unbent, Breaker of Facial Muscle Chains.

He briefly said some glowing things about Dr Osundwa, ribbed him a bit. Dr Osundwa laughed despite himself. You could tell he’s a serious fellow, one who lives his life by the clock. One who never once in his life  stopped to watch a cat video. He looked like the type who hardly takes a vacation but when he does he carries a very big book, non-fiction, and reads it by a very blue swimming pool which he won’t get into. He was from another emergency surgery, he said. His life seemed to be one emergency after another. 

“This gentleman is a writer,” Dr Bartuiyot told him. He said it in an accusatory tone that made me chuckle. Like he was reporting me to Dr Osundwa. At the same time, beyond a doorway where patients were received, Joseph’s mom was handing over Joseph. She was crying because her son is only one year old and she had never been away from him, never given him away to strangers. She didn’t know if she would see him again because sometimes people go into surgery and never come back. 

 

A nurse came carrying Joseph and a red file. He looked so small. The two doctors followed the nurse into the theatre. This surgery – as with many of its kind – will be on Smile Train and Getrude Hospital’s bill. It was cold inside. A scrub nurse – Euticus Mugendi – was arranging instruments silently with another nurse at a long table against the wall. Clean shiny and sharp instruments; garry pots, dissecting forceps, artery forceps, blade holder, catheter, curette, mosquito forceps, towel clamp. Somehow, it all reminded me of Anthony Hopkins. 

Joseph is crying. He’s scared. He’s not used to strangers around him, probably wondering why they were all crowding him. What were these cold things they were strapping on his chest? A machine’s beeping. He’s kicking and crying. Suddenly Dr Bartuiyot isn’t the goofy guy he had been, he’s serious now. His hands were moving. Everybody seemed to know what they were doing, except me. I stood watching this room come alive. Emily has been in the theatre countless times. She was seated on a stool, wearing funky black scrubs, looking at her phone. The digital clock on the wall announced that it was 9:17am. Someone placed a mask over Joseph’s face. Gas hissed. A needle went into a line on his arm. Everybody was moving, it was a stage and they were actors who knew their roles.  A perfectly choreographed dance where nobody was stepping on anybody’s feet. 

Joseph suddenly stopped crying. They taped his eyes shut. Dr Osundwa said something about dryness , to prevent “corneal abrasion.” I wanted to ask, corneal angowa? But this was not the time and certainly not the place. They placed a pillow under his head. Dr Bartuiyot sat next to the big noisy monitor that had colourful lines running across the screen monitoring Joseph’s oxygenation, the rhythm of the heartbeat and his breathing. They all stared at it, looking with their ears. 

 

A slim nurse spoke up, “we will do the introduction of those in the theatre,” Everybody does: Dr Osundwa- surgeon, Dr Bartuiyot- anesthesiologist, Euticus Mugendi -scrub nurse, Emily Manjeru – Smile Train, Jackson Biko- writer “and I’m Sergon Jepkrui- Nurse,” she said. She also mentioned the patient’s name and why he was being held against his will on that table. She said something about the unilateral right side so that they don’t remove his spleen instead. “Last meal, midnight, weighs 6.8kgs,no allergies,  pulse 138,” she said, his height which I didn’t catch because I was staring at Joseph’s feet; so tiny, so many miles to walk literally and figuratively. Joseph will never remember this morning, I thought, he will never remember that the men and women gathered around him to give him a chance to have a normal mouth, a smile. People will ask him about the little scar on his mouth and he will say he doesn’t know. That he was born that way. 

When Sergon was done reading the preoperative checklist out loud, the work began. Only Joseph’s mouth was exposed under the sheet. Using a marker Dr Osundwa drew on his lips; a surgeon and an artist…or a surgeon is an artist. The light overhead was so bright you could count his melanin cells. He worked slowly under the mask, his spectacles off, head bowed. It felt like he was doing God’s work.

I always thought surgeons operated with music on. Something light and unaggressive, something you hear but don’t listen to. Jazz, perhaps. But there was no music. Just the sound of the beeping monitors. Or Dr Bartuiyot saying something. You don’t work with music? I asked Dr Osundwa. “Some surgeons prefer to operate with music but it’s not my style. Personal preference.” He said. “I like to hear that monitor beep. It keeps me focused. And if there is a change I want to immediately pick up on it. Music might distract me.” He cut and snipped. Euticus stood opposite him, soundlessly handing him instruments. They worked without exchanging many words. In synchrony. 

 

They started incising Joseph’s lips, cutting it to the nose. Blood oozed. Euticus swabbed. I looked away. It was gory. To fix, it seems, you have to first undo. I sat far away where I couldn’t see what was going on, away from the blood. Sergon laughed at me, “this is nothing,” she said. Dr Bartuiyot sat with an eye on the big monitor, occasionally writing notes. It’s a small but important surgery for Dr Osundwa, a little over one hour. He’s had surgeries that run for over seven hours. “You have to keep wiggling your toes,” he said. “But you build stamina over time.” His hands are steady. It helps to have steady hands as a surgeon. But it’s not that surgery that he’s passionate about because when not holding scalpels, he holds hammers and nails. He’s a carpenter. He does all the woodwork in his house; building shelves and repairing cabinets, laying parquet floors, fixing drawers. He loves wood. He loves to work with his hands. 

And together their hands – his and Euticus – did this synchronised thing; opening, handing, cutting, dabbing, the machine beeping, the room humming with muted activity. Joseph lay under the blue sheet; neither alive nor dead, in this place where men like Dr Bartuiyot take them, a place between life and death, like purgatory before the fates work to draw you to either side. A beautiful place because you are no longer responsible or even aware. 

“Maliza bwana,” Dr Bartuiyot said jokingly. It had been slightly over an hour. Dr Osundwa was just doing the final touches, you know giving his handiwork the final polish because what they do is art. “Come and have a look,” he told me.

I walked over and stood over Joseph. It seemed surreal. This was a completely different mouth from the one that was carried in. It looked like a proper mouth that would slowly relearn to suckle. A mouth that would grow to talk and eat and laugh and kiss some girl one day. At school, nobody would laugh or make fun of  him or think of him as an outcast or a freak. His personality would not be pegged around his mouth. He would lead a normal life. A life of smiles, when they came. 

He’s started stirring. It was amazing seeing him come to. The room was suddenly a buzz of activity: Dr Bartuiyot hovering over him, touching this, and that, removing his eyepatch, someone wiping his mouth, Dr Osundwa stepping away slowly in the shadows, pulling off his gloves, his work done, Joseph making guttural sounds, like snoring sounds, someone placing a gas mask over his face, the gas hissing through a tube and into his lungs, all the while the trays being pulled away, people cleaning, wheels on floors squeaking as tables are shifted, the beeping sounds on the monitor all changed. Joseph was coming back. With a new mouth. 

He will end up in a recovery unit, a nurse by his side. When he comes to he will be scared, irritated, even pissed off. He will be confused and groggy. Everything will be so bright and unfamiliar and he will wonder where the hell his mother is. The nurse will rock him and coo and tell him what a swell and brave baby he is and he will not want any of that shit. He will be hungry. He will want warm milk from his mother’s breast, not words of encouragement. He will stretch his legs and arms in displeasure, trying to kick free. When he’s recovered enough, the nurse will carry him through the big doorway to where his mom is seated asking Emily questions; is Joseph OK? Are you sure? Did you see him? 

As Joseph is lowered into her waiting arms she will look at him with wonderment, like he’s a gift. She will touch his legs and arms to check if he came back without them. She will study his face. His mouth. She will smile broadly, with relief. Joseph, still mad, but not so mad now that mom is here, will cry because he’s one year old and he just came out of a weird place, because he doesn’t understand. His mom will talk to him in Kamba, call him by his nickname, a name that is not his colonial name, a name of endearment, a name of intimacy. He will calm down a little. She will look up at Emily and say with a smile, “he looks different.”  

That, he does. Like a completely new boy. 

Oh what a difference your mouth makes.

At the doorway, a Somali family will be saying goodbye to their son with half a bandaged face. The one whose face got smashed into by the sink. I will briefly watch through the small rectangular glass of the swinging door of the theatre as they prepare him. 

Dr Osundwa and Dr Bartuiyot will be preparing for yet another dance, their gifted hands ready to perform another miracle.

 

***

 

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83 Comments
  1. Biko
    His face was a mess, like a prop in a horror movie
    In your afterlife, at the time and age when we won’t have political campaigns and wars btw nations, there may arise a need for a sililes currator
    You will be the principal of that sch
    Today is a long good read
    Shagwez

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  2. Its surreal. The photo before and after surgery. Thanks to the great team, Dr Osundwa, Dr Bartuiyot, Euticus, Emily, Sergon, and the financier – Smile Train.

    Dr. Osundwa surely deserves a cat video. 🙂

    Eldoret is in Uasin Gishu and you must have been to Eldoret Biko.

    Keep winning

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  3. My sister had cleft lip waaaay before Smile Train happened. I’m talking early 80s.
    Eventually she got help. But she still ‘talks through her nose ‘ , her ears get messy sometimes, she’s very prone to eat infections. But she’s alive. And doing great. I’m really glad Joseph got a smile

    Halafu Biko, hio story ya sink I know I can’t be the only one who wants to know exactly how it went.

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  4. Everyone wants to go to heaven, but no one wants to die – Robert Kiyosaki.

    God bless doctors for heeding God’s call in their lives; making peoples lives comfortable and for prolonging life, enabling many a brand new lease of life.

    It’s unadvisable to make negative declarations before surgery. Put angels to work by declaring you will live to declare God’s goodness and it will be so. It is sad for people to leave before their appointed time.

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  5. Haunting. Thank you Biko. You brighten my day and give me something to look forward to. Life has become monotonous and it’s great having something exciting to look forward to

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  6. To fix, it seems, you have to first undo. ..beautiful read ending with a beautiful smile.
    Thank you Tom of House Osundwa, First of his name, Slayer of Cleft Palates and Protector of Children and your entire team.

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  7. About the 22 pts in one shift, read about something we call Murphy’s Law.
    On the cold sausages; when you are free, to pass by the lounge, you find other colleagues having already eaten, so you naturally fear that the food has already been touched and end up leaving it. or your mind is not in eating as you are still worried about the pt in bed 4 whose vitals keep fluctuating for more than 7 hours now.

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  8. The light overhead was so bright you could count his melanin cells.

    I was staring at Joseph’s feet; so tiny, so many miles to walk literally and figuratively.

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  9. You cannot join the KDF as a Captain can you? I’ve checked the ranks on the MOD portal and it seems impossible. Someone please clarify this for me.

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    1. They are called special duty officers (Doctors, lawyers, engineers, architects, teachers, etc.). These pass out as Lieutenants or captains.

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  10. Lovely story but your soured it a little bit by mentioning “Gifted Hands” at the end. We are still recovering from the fact that the world lied to us that Ben Carson was really smart. We all wanted to be neurosurgeons etc., because of him and 2015/2016 taught us otherwise

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  11. Wooow…the transformation is real.wishing the little baby lots of love and light.
    I know it’s a sigh for the mum too.
    Thanks Biko, Dr Tom and team for an amazing job. keep up the beautiful job!

  12. “It’s life. It shocks you, yes, but it happens. Death is a part of this job. But so is life.”

  13. Today I will comment because, you have finally touched my area of trade. Thank you for recognizing the hidden gems of the hospital. May God bless all perioperative staff wherever they are. Quick recovery to baby Joseph.

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  14. Such a beautiful ending and encouraging. Great writing too. Slowly recovering from the girl eaten by leopard story.

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    1. To think that this was also part of her journey.
      May God she always feel the grasp of God’s hand and comfort.

  15. I walked into that theater with you Biko and watched as the team did their thing.. The description is so vivid.

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  16. Wow.
    What a difference.

    Wow.
    Those gifted hands performed magic.

    I’m truly in awe..

    Thank you Team Smile Train . Thank you surgical team.
    Thank you to Operation Smile if they still do exist.

    And thank you Biko for taking us with you.

    A picture is worth a thousand words.
    Loved both words and the accompanying photos.

    May God continue blessing all those people who use their talents to the fullest.

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  17. Must you mention tits this morning?

    Anyway Biko I love your humor esp here
    ”Sometimes they throw smiles out the window when they can’t stop and children running after the train grab these smiles and wear them and go home and their moms ask, where did you get that smile and they say, from the train, mommy, the smile train, and suddenly the homes are filled with so much joy because nothing bad grows around the smile of a child.”

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  18. When my five year old son was taken to the theatre for a heart surgery, so many questions rocked my head. Will he come out alive, how will he handle strangers, was the procedure painful and most importantly was there another option?
    Right now I can feel the dilemma in mama Joseph.
    Anyway the procedure was a success and my son is now OK
    All the best to Joseph

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  19. Surgeons are great people, good work Dr Osundwa and Dr Bartuiyot. May God continuously energize those hands.
    This reminds me of Ben Carson’s book “Gifted Hands”

  20. Biko you have captured my most precious moments when I get to attend to children. I am an OR nurse but doesn’t get to work on them as often as I wish because we don’t get as many children needing surgery…or parents affording to bring them to where I work.
    One day I will be working at Getrude’s Children Hospital. One day soon enough. And I will remember this feeling.
    Smile Train doing an amazing job!

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  21. The transformation!!! Definitely the work of God!

    Dr. Osundwa is also the most amazing Dentist! Very kind and gentle.

  22. Wow, a wonderful story, and with pictures. Biko you have a wonderful way with words, weaving an intriguing story that one cannot stop until they get to the end. But that sink story is still not finished bwana..

  23. What a miracle. What a nice article. God is indeed good, all the time. Thanks Biko for such a heartwarming read.

  24. Dr. Osundwa is a legend! I was introduced to him when my mouth/teeth were a mess. A terrible mess from a filling gone bad. He fixed them so well, so patiently. God bless him. So happy Joseph got his miracle.
    HIs clinic is Bethany Dental and Maxillofacial Center on Argwings Kodhek (I just had to do a little promotion there 🙂 )

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  25. Beautiful read. You took us on a mountain hike, then into an operating theater. I kept holding my breath. Cold sausage, that hit me differently. I must learn to write like this. I’m soon joining your creative writing class.

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  26. Only Biko can write a medical journal kind of thing & the story is captivating!

    May God continue to give our Doctors & Nurses wisdom in their work coz it is truly miracles that happen in theatres

  27. This is so beautiful. Doing God’s work indeed. You’re doing a great job creating awareness about clefts and where help can be found. You’re doing God’s work too

  28. The smile train…, I know of a group that call themselves; Operation Smile; They are Santas’ of Smiles; God bless them

  29. I read and cried because God has delivered them to me, three of them, all perfect. I always count their fingers and toes to confirm the number. I cried because I take it for granted and assume it guaranteed, it’s my right.
    So, I marvel at the bravery of Joseph’s mother and others who have bravely handed over their lo for surgery. I marvel because one time they said my son’s tonsils were huge and may need removal, I went into months of fasting. Eventually, he didn’t need it after all.
    It’s a beautiful heart warming story. God bless medics.
    It’s called ‘midas touch’ Biko, that thing of losing many patients in a day.

  30. Wow, that was worth reading. Joseph is blessed and so is the team that was in that theatre room. That was a good read. Good job Biko!

  31. The exhilarating piece has kept me riveted and enthralled the entire evening. Informative, inspiring story. God bless the scrub team

  32. Ahhh Barti my friend!
    You described him to the tee Biko!

    Awesome team right there.
    Light to the world through smiles.

  33. Omg! The work done on the boy was so beautiful. It almost looks like magic! Well done to the Doctors and nurses who did the surgery

  34. “This gentleman is a writer,” Dr Bartuiyot told him. He said it in an accusatory tone that made me chuckle. Like he was reporting me to Dr Osundwa. At the same time…….reminds me of primary school when the teacher would storm into class as u were making noise and the prefect would immediately point at you…….”this one is the noisemaker”

  35. Thanks for this Biko.

    My son also had a cleft palate. Only that his was hidden inside his mouth and we only realized 2yrs down the line.

    We underwent the surgery at Gertrude children hospital as well under the smile train when he was 3years. Am always grateful to them

    The surgeons were surprised when they saw my son’s and said it was rare and unique.