Medicine Meets Something Mediocre.

Loliondo!



Most people with a care for recent history will recall that flash-in-a-pan phenomenon of 2011. For a short while this name took the world by storm. Who will easily forget the long winding lines of caravans from across East and Central Africa making their way to that till-then obscure locality in Northern Tanzania. Who will forget the same masses faithfully gulping down cups upon cups of the cherished cure that went for Tsh 500? Kikombe Cha Babu as it was aptly called was this magical elixir that cured all ailments. So you can only imagine what a sensation it was expected to cause. From the incurable HIV to the very troublesome diabetes and erratic hypertension, Kikombe Cha Babu spared none (sounds familiar?) Not just this but even the apparently well people just had to insure themselves from future incidences of sickness. Heck even Tanzanian MPs were not to be left out on this seemingly once-in-a-lifetime-chance at a cheap remedy gravy train! A Health cabinet minister (a doctor herself) sanctioned it..

A Public Security Agent Drinks From 'The Cup'!

And so it happened that a remote outpost till then known for some other reasons took the centre stage with the world media shining its full glare on it and thousands upon thousands of hopeful visitors thronging it. At the centre of it was a respectable retired church Minister who claimed to have received a vision about the cure. The substance in question happened to be a local shrub which had other uses before then. Its derivative was actually a lethal poison used to kill lions in the inevitable human wildlife conflict, the area happening to neighbour a national park. And so Reverend Mwasapile aka Babu had gone to work and the world had come to him.
Hospital beds had rapidly been emptied of their occupants and so had many chronic disease and HIV treatment programs.
I was working at Bondo District Hospital then. Before we had grasped the magnitude of the issue so many patients in our care had already made the all important expedition and were already waiting among the frenzied throngs in Loliondo. Then we had made it a point to do a routine talk on the baselessness of the claims. But alas!
A friend of mine who was on follow up had confided to me about his intentions of making the journey. He had quietly listened as I tore through the inaccuracies and laid bare 'facts' surrounding the said concoction (but what did I know about it really?) Alas, poor me! Who was I to stand in the way of a brother who only desired the best for himself? For gone he had, his mind having certainly been made up about the entire business.

Then like all bubbles this one too had burst. It had come in the most tragic but expected of ways. Patients who most likely had been pulled off important lifesaving medicines and secure environments had died awaiting their turn at the cup. Not one, not two, not three but fifty plus two according to the official figures released. Only then had the concerned authorities acted.
But even before this it was easy to see that a disaster in one form or the other was looming large over the village. What was hard to fathom is why authorities looked the other way as matters slowly but surely came to a head. The evident humanitarian crisis alone should have been an indicator to an impending implosion. But such is the way that authorities this side of the world manage important public affairs.

Winding Lines on Their way To Loliondo.

The aftermath of this debacle remains untold but if consideration is taken about the toll of these happenings on the public health system then it becomes clear why healthcare remains one of our biggest challenges.
The drug changes, the worsening morbidities and even mortalities (all of these easily preventable). Name them.

My form two definition of faith remains very clear, "hope for unseen things". Is it what we now have all over the place? Is faith wholesomely dispensable like a prescription? Is the production of a token equal to the manifestation of faith? Many Men of Cloth will have you believe so. For what ends? But only if they went about it with less pomp and more humility. And so it happens that one of the silent thorns in the side of conventional medicine are characters of dubious distinctions who for one reason or the other have been left to operate with unwarranted abandon. Scorning miracle healing is far from my objective but preying on a desperate and thus gullible public to sell their 'wares'? But truth be told, the conundrum that is the public healthcare delivery system is not helping matters either.

I was very young in my practice. Just fresh from internship and very eager to exercise that hard won independence. It is thus to be expected that I saw the world of patient care in only two dimensions; my way and my way. This arose from two weaknesses on my part; the inability to well harmonize theory and actual practice and secondly a shaky grasp of that trifling thing called human nature and conduct. Every new lad in the field goes through the same. So I had seen this middle aged lady with very non specific complaints. My work up had of course included HIV and it turned out positive. Applying tonnes of counselling to the point that I nearly forgot to treat her for the more pressing problems. We had enrolled her in our care unit and I took particular self imposed responsibility for her, she being my first patient to fully deal with right from start. It delighted me that I was now digging my teeth in the otherwise confounding world of HIV care. Scheduled her for sample collection, I gave this business the very best shot and my especial personal touch. Alas!
She did not disappoint at first, dutifully keeping her appointments and seemingly keen on her care. Well till tragedy struck! She met this pastor. And away flew my bird. She defaulted and made it clear that she had found the path to her healing and would keep at it and no other else. I expressed my utter incredulity but nothing could change her mind. Later at the instigation of the very same pastor she had even claimed that we had lumped a wrong status on her; she had never been infected in the first place. The scoundrel. Off she had disappeared in intercessionary schedules and because of many other related reasons we had given up on her.
For some months matters had gone well with her. Well just for some months before she began on a quiet downhill slide. Then the prayer sessions had increased (we maintained a discreet interest in her affairs!) Till it was very late. Then she had died. Case one.

A much beloved high school principal in one of the schools near our facility and whom we had been seeing left us a bitter sad pill. Diabetic and hypertensive it however alarmed us when he started skipping his appointments and going for weeks without his medicines. At first he gave vague reasons for his conduct. That he had seen another physician who had recommended other pills and such like stuff. Of course we trusted that a high school principal must know better so we bothered him no more. It was not before long that word lazily floated on the air that he was actually seeking the intervention of a famed Woman of God not so far from the facility community. Damn!
We have all heard what a deadly combo diabetes and hypertension can make. So here was a man at his prime who had been under good control but who nevertheless thought he had had enough of the daily pills. But for what? He stood no chance. He could for days remain holed up in the lady's premises under her ministrations and word spread that he was on a steady decline. Aloof to the advice of his colleagues it was now in the open that for him it was just a matter of time. He had developed a stroke and one can only imagine what havoc the uncontrolled sugars were playing on his fickle systems. But adamant he remained. He succumbed in this setting and only rushed to hospital when it became apparent he was no more. Prophetess had lost such a high profile and well paying client but you think he would be the last? Case two.

A cup, just one cup will cure it. The rich and poor, elite and unlearned alike all put their faith in a cup of something from one Babu. Any health professional who believes he has seen the last of these miracles cures is deluded. Every day on national TV, radio are these adverts for all sorts of unfounded healing claims. Newer, fancier pastors, herbalists, waganga et al promising heaven only to dispense hell. (Both physical, spiritual and financial). I bet that's how the world operates..

Absurd Rape Related Tales..

One day, in the not so distant past I was seated in The Hallowed Consultation Room just lost in The Muse. The time was around 2030hrs and I was covering the night. Worn out from my daytime activities I was using the downtime to unwind and unclog my mind. And so as I leisurely reclined in my seat painting fantastic mental pictures I heard a knock on the door but even before I could regroup all my faculties back to reality in peeped the night security guard who took the liberty of inviting the two (actually three) fellows behind him in. Well I had to scramble back from wanderland (yes wanderland) and fast!
I went through the preliminary part of the consultation; just confirming the name, age and so forth. It was a very young couple, the man was eighteen (was able to determine that) while the lady was nineteen. They had with them a three year old girl but from the woman's earlier relationship. Married only for a few months, they were now expecting their first fruit of love together, the lady being about two months heavy with child. I had initially thought it was the child who was sick but the card read the mother. Then I had inquired what the problem was. Silence. Fidgeting. More silence.

We have been taught never to speak for a patient; a patient has to state his case in his or her own words and it's your duty to figure out with precision what they mean. However you may paraphrase or ask with tact to establish what they have said. So here we were. Checking my demeanor I asked again in the gentlest of tones what it was that had brought them to the facility. Furtive glances and some half attempts at speaking up. Then the man had eventually surmounted the difficulty by imploring the wife to state the issue.
Not able to maintain eye contact at first and fidgeting some more she had eventually explained that the previous night somebody had attempted to rape her. Damn! Where? In their house. What time? Around 0200hrs. How? The intruder had told her he wanted to see her husband and so she had believed he was friends with hubby.
Now the problem was this: the husband was not at home at that time and they being new in the place he expected no night visit from any friend of his. He was doing night duty at his place of work that week. Intruder had however insisted on being admitted saying he had a message for the husband. Well on entering he had cut to the chase and threatened her with a dagger. She had not seen his face for he had moved like the devil himself. This is where it gets twisted. He had not been able to manage intercourse due to a defensive manoeuvre she had adopted and so defeated in his evil designs he had quietly slunk away into the dark night. Real Creepy.
No hair touched, no bruise sustained, no blow given, no alarm raised, nothing but a lone shaken woman at a ghostly hour of the night. Believable? The hubby hardly believed a thing and seemed very riled though he appeared one of those meekly indisposed, gentle characters. It's here that he wanted me to come in. To establish if at all there had been penetration; he had heard that it's possible to examine and know if someone has been raped. Damn, Mungu Baba, saidia hapa!
I went over the details slowly and meticulously. The lady now confident and with a reassuring telling was however adamant that nothing happened, no penetration, no intercourse, no sex, no rape. Nothing. In my own assessment her tale had a ring of honesty to it. The husband however persistent with his hows just could not buy it. I understood his cynicism and so tried to reassure him by pointing out that it made no sense for her having even told him a thing if she was a willing accomplice in the business. She had tried calling him after the scary ordeal but he was apparently sound asleep on duty.
He had never doubted her trust before and nothing so far had occurred that made him have doubts on her fidelity. Same to her. I went through the paces of detailing the post rape protocols and everything that had to be done, explained what risks there were to her and the fetus and that if any intervention needed to be made then we still had time but she stuck to her word. Nothing had happened. At that point I chose to fully believe her.
A private session with the husband and I was able to make him understand that though it was hard for any man to come to terms with anything like that we had to believe her all the same. They had however to report the matter to the police because criminals always left an unmistakable scent or two. Trust Sherlock Holmes to unravel a mystery of this nature and nab the ghost-like, faceless, night time prankster. And who knows, he might have wanted to part hubby's neck from his head. It went like one phantom tale, but true it was. I became more afraid of the dark some more and for some days slept with the lights on..

• 
  

The hilly terrains of Iten and Cherangany and Kapsabet have bequeathed us with generations upon generations of nimble sure footed gifted track athletes, world beaters who have represented us well on the very competitive global stage. It's also true that many of business magnates and captains of industry spent their childhoods braving the morning chill of The Aberdares and Mount Kenya. Now there is in this country one county famed for it's very decent professor-per-village ratio. With many sons of the land well settled in many notable research and academic entities the world over it easily occupies the enviable position as the undisputed hotbed of scholars in the country. It is here that we now go.
Any clinician or nurse or physician or any of the health professional for that matter will tell you they have met some very confounding cases in the course of their work. But it has to be noted that many of these confine themselves to the medical or scientific aspect of things. Any social dimension taking the centre stage in a case and we beat a hasty retreat into our nauseating doctor or nurse cocoons and refer to the counselors, psychologists, pyschiatrists or even the police and the administrators. This state of affairs is however to be understood and the medics are not to be begrudged, they already have much going for them already and almost all training curricula are so deficient in this aspect.

So in the land of scholars one Saturday morning at the OPD/A&E of one of the county referral hospitals, the outpatient crowd sat patiently and orderly waiting in turn at the waiting area. The departments were still very sluggish, what with some of us preoccupied with the usual silly extra-hospital banter and gossip; but the patients and their relatives waited with unbearable patience all the same. Then waves of guilt hit us like the dry heat of The December. Were we really doing justice to whatever it was that paid the bills albeit belatedly? Was this how we repaid back the government after gifting us a hefty extraneous allowance! So one by one we had trooped to our stations and settled down to work. And work we did for in no time the crowd had been conquered!
When you work in the accident and emergency department of any hospital you are always putting out critical situation fires. Serious injuries, shocks, comas, grave complications of all sorts. You are literally in the firing line of things. Speed, sound judgement, experience, patience are all of utmost importance. Then can you hone your competence. But you also get to meet some of the most baffling real life situations that only highlight how deep a well human nature truly is.
And so as we had gone about our work on this particular Saturday morning, a commotion outside had drawn all our attention. A sobbing lady of about twenty two was hustled into the area. She was disheveled and in such a sorry state emotionally and physically. Hot on her heels was the mother, apparently. Also in tow were several relations most likely siblings to the young lady. Mother was fuming, agitated and in no moods to display any etiquette of following the laid down regulations. She headed straight to the nearest consultation room which happened to be mine! They half pulled, half supported the daughter inside and she slumped into the seat. Then the rest of that no nonsense entourage followed, all evidently ruffled and using some of the choicest not-so-nice English words. I let them vent and ventilate for a minute or two before I cracked the whip demanding order and decency. As a condition for anything to proceed I requested they all leave the room except the young lady. The mother insisted on remaining. I grabbed some writing material and dug into it.
"She has been raped" bursts the mother.
I calmly ask to let the lady speak for herself.
"Can't you see how distraught she is?".
I however insist and kindly request the mother to leave the room. Then she beats me to it, rapidly launching into how the suspect waylaid the daughter the previous night and sexually abused her the whole night. She had only been able to make her escape in the wee hours of the morning after the satiated and worn out beast had slumbered off.
I asked the lady to corroborate the narrative but all I got were sobs and more sobs. I sat back and quietly regarded everything. Then out of idle curiosity asked if they knew the suspect. She told me he had been apprehended by the police. However as if on cue another commotion outside revealed that the suspect had been brought to the hospital. Badly beaten, he was bleeding from many scores.
I requested the lady to lie on the couch so I could examine her. She complied and I completed the assessment noting down my findings. After establishing she had not changed her clothing nor had taken a shower I explained to them that we needed to get some samples for lab investigations. It's like the mother had been waiting for this important piece of information. Urging me with uncommon vigor to speedily get done with it. They needed to lock away the unfortunate, worthless and mannerless mongrel.
Then the daughter snapped.
"Mum, why are you doing this to me, how far will you go to achieve your mean objectives? Denounce me but kindly let Kevin go, he is just a poor innocent boy, please mum, I beg you", young lady had hysterically broken down, inviting some alarmed colleagues and even patients into the room.
"You shut up, disgraceful scoundrel, you are a total embarrassment to my person and the entire family. Messing around with poor, pathetic scumbags, is that what is expected of you?".
I was by that time stupefied by the unfolding drama and remained rooted to my feet, I have seen some melodramatic Nigerian movies but only believed them to be sweetened tales. Now here I was!
"Daktari, can you kindly proceed?". the mother roused me from my incomprehension.
I asked to be told what exactly was going on because it looked to me some stinking fishy bit of business.
"Which part of 'she has been raped' don't you understand?".
I inquired from the lady what had then happened. She tells me Kevin was just her boyfriend and she had willingly spent the previous night with him. She was stopped midway by two well aimed slaps from the mother amidst a torrent of unprintables.
That being the case I tried to explain that there really was nothing much to be done here. In fact nothing at all. Wasting valuable daktari and genuine patient's time in this manner was not so cool. Complicated matters of rejected choices were best handled privately and civilly in chief's courts or behind their palatial residences.
"Test her for HIV", barked the mother, evidently smarting from her temporary setback.
The daughter saved me the trouble by flatly declining to have anything to do with a forced HIV test. Out went the mother cursing and wailing and making such a scene that you would certainly believe the greatest calamity had struck home.
Compelling the young lady to compose herself I was itching to get to the bottom of this trifling matter. It turned out to be nothing but a rich girl, poor boy antagonistic family story. She was from a very well-off family from the neighborhood. The mother was a college lecturer, the father a university don. She was herself at the university pursuing a degree in fine arts. Her boyfriend who she confessed to love dearly was in another campus pursuing actuarial science. He was however from an underprivileged background and thus her parents would have none of that social tomfoolery. Only that? Yes. They are despicable egotistical maniacs who have gone to very laughable lengths to achieve their objectives. They have bribed the police and the chief to fabricate and backup this rape story. But they will not succeed. I need to see him daktari.

It would be expected that in any community with a significantly big proportion of well read people would also boast of a corresponding social advancement with scant prejudices and full of understanding and that elusive erudite pity. Wrong.
I can't clearly recall how those Nigerian movies ended. I can't say how this one ended either. The family left the hospital in a huff, young lady remained behind with her boyfriend who was still under police custody though undergoing treatment for his injuries. I asked a police friend of mine how they felt being in such farcical and ridiculous situations and being used thus and he just laughed.

Brothers in the Deep End..

I have in my village a very wealthy decade-shy septuagenarian who has made the bulk of his money selling meat. Now he himself is a vegan. He made the rest of his money supplying cane to one of the moribund sugar factories in the countryside. He takes no sugar also. Life must be one bland tasteless affair for this tycoon then! You would bet so...but such is life.
Then we have all heard about great teachers whose own sons or daughters turned out epic academic failures. Not in that rude sense of below par cerebral abilities but in a more socially humiliating manner; truancy, obstinacy, utter contempt and rejection of the academic life. These sons and daughters of famous teachers have ended up the village vagabonds, well steeped in notoriety and went on to lead pitiable base existences. Well some of them. There was an age when teachers were one of the foremost elite professionals in the neighborhoods. They commanded an unquestionable, unadulterated kind of universal respect that was well earned and merited. This may not be still the case but the reasons for this are not the objective of this post. It is then baffling how some of their sons and daughters turned out to be the complete antithesis to all that these noble souls stood for; the embrace of knowledge and all things knowledge. Little paradoxes that stack together to enrich our existence and make for the colorfulness of everything, but then such is life.

The morning ward round was rather uneventful. Just the usual cases to be encountered in a busy private hospital. Well till we got to the male ward. One of the night admissions was a middle aged morose man. Here is the brief description of the case. Brought in at three in the morning with bruises following an assault at a man's home that also doubled up as a cheap liquor den. The details of the events are embarrassing and tedious and so I wont go there but the long and short of it; well some money owed and some bills unsettled. So he had sustained bruises and lacerations here and there. He being rather weak looking and with a lanky physical disposition it was obvious the opponent or opponents had gotten the better of him and that he had borne the brunt of the altercation. He was as they say dead drunk himself then. And so a few friends who had intervened had brought him to the facility. 
On examination it was discovered he had a lower chest infection in addition to his physical injuries. He was also known to suffer from gastric ulcers. He was started on the appropriate management at admission and this involved reviving him since he had passed out at some point. Enough of the case though, now the man himself.
Forty years old, separated with the wife (a nursing officer practicing in Nairobi), with one known child (daughter in form two) he was a public health officer by profession. He was however now living like a homeless dog in the backstreets of the township. Mr PHO came from a very rich academic and political family. It really is to be believed that some persons are favored with very special powers of the mind, for despite his well known enmity with sobriety he still managed to pull in some decent work. How he managed is still a subject for scrutiny but manage he did.

I won't be the one to judge any one who waddles through life the way he chooses to in the name of living it. And so I won't criticize Mr PHO for having sort of a very open social life; sleeping wherever a door was open to him and only going back to his resident hostess (a cheap liquor vendor herself) for maybe a change of clothing. Needless to say, he enjoyed very dire financial circumstances perennially. He was the object of ridicule and derision in the community.
So we had seen him in that ward round, run some tests and recommended others and retained him for continuation of treatment. Many hours later he requested to see me privately. Says he, "doc I am required at the office for some work related reasons."
Me; but you are sick, I mean you are sick, what is so urgent over there that your illness has to be suspended?
He replies; I know that but I can handle it, I just have to be there myself.
Me; can I talk to your boss myself and maybe make him understand or rather believe that you are unwell?
He; oh no, I would not bother you with that, let me just then explain to him the situation.
Me; doc, now that we are here I think it's important I point out something that I meant to talk to you about. It has to do with your drinking and smoking. You well grasp what a precarious place the two have led you to. You are not any ignorant fool out there...you have been on this road long enough to understand its perilous destination. you understand the effects on your health.
He; I understand everything perfectly well, though you must realize how hard it is on me.
Me; I appreciate how difficult it is and that brings me to my point. You need help, serious professional help.
He; oh doc just do what you can do the rest will come in time..
Me; now this is equally important just like anything else that we will do for you. Your recovery is of top priority now and I think this is best addressed now rather than later.
He; doc let me be frank with you for once. I have tried many remedies and gone through many extreme paces to reform but only met with disappointment after disappointment. As you see me now I am just resigned to fate; let be what will be. You know this thing runs in our blood. I won't be the first nor the last to go down this way.
Me; (after some brief pause) you really need to encourage yourself, you are still very young, at your prime, why would you throw away such a productive life at the price of a penny?
He; no one would mind. In the whole wide world no one would miss me, because no one cares and that is my only consolation.
Me; now is there any particular way that we or I could be of help?
He: yes, we could start with an immediate discharge from the ward now...the rest will come later.
Me; huh!

I ended this conversation on that unpromising and resigned note. A cloud of defeat had never hung any heavier than it did around our consultation room. 
The precursor to this conversation had been a visit I had received earlier that day from an acquaintance of our friend. She had urged me to do anything within my power to insist on his rehabilitation as a key factor in his treatment. We had briefly discussed it and she had given me a number to call; our patient's father. Many life situations will come our way. In facing them options are always open to us. Sometimes too many options. Sometimes just one or the other. Choosing one over the other may make all the difference. Extracting just a tiny fraction of learning from the myriad possibilities is an awkward preoccupation of mine. And so I had called our PHO's old man who was himself a retired nurse but then engaged in private business.

After the usual introductions and niceties had been gotten out of the way our conversation took this turn;
Me; he needs help now more than ever.
Old Man; (after a momentary pause) he should himself realize that first. Then we can only come in to facilitate. We have in the past been the initiators of many a process and all our good intentions and noble efforts have always come to naught. As it is we are all resigned to fate.
Me; a one last grand effort; a concerted effort bringing together his family, his friends, his colleagues maybe?
Old Man; huh! I would never be the one to waste another man's time in vain pursuits and endeavors. Do you even believe he has friends? Or any friends who would care for his well-being for that matter? Let me ask you something young man.
Me; Yes?
Old Man; how old are you?
Me; thirty something.
Old Man; and how old is your patient who happens to be my son?
Me; forty.
Old Man; a man of forty should be very embarrassed with himself for leading his life like a homeless dog (I was stupefied by him for expressing my very own sentiments in the exact same words), he went on; I feel the humiliation very acutely myself but I have tried all the known tricks in the book. Nothing has permanently worked. I will be very honest with you; I have even consulted witch doctors just in case you know how our people are, just in case his addictions are the product of some malicious underhand efforts. All I have got was more and more disappointments to add on my expenses.
Me; sorry to learn about that, it really must be heartrending but all the more the reason for a last grand effort at rehabilitation. As we speak now I believe even a visit from his relatives may do him some good since he feels abandoned and neglected.
Old Man; but I can not drive all the way from Eldoret just to come and see him, and above all he has brought all of that on himself. In reality I can't summon the strength to realize that all I can do for him can't go any further than mere pity. As it is I am resigned to whatever designs that both fate and the devil may have on him. 
Me; don't you believe that that very effort from you might make a positive impression on him? Or anyone you know who may be of help here, his wife maybe?
Old Man; I am positively persuaded that it may have no impact whatsoever. It would thus be very pointless of me to hazard the ramble. I can not speak for his wife either, i can't bother her even. As I told you already we have left all to the will of fate.Till then we still pray for him and as for now daktari do whatever you can do for him.

Thus had we ended our little discussion and then I had grasped the depth of the hopelessness of the situation. So I had intended to speak to Mr PHO myself and as he had happened to bring himself my way so had our chat passed as earlier described.

Thus passed he the day rolling up and down the hospital grounds, but what happened in the night was one of those occurrences that really torments a man's patience and rudely fries a man's cool. Not being able to hold out any more and finding his getaway efforts thwarted at every turn Mr PHO had played a smart one by having the liquor brought to him instead of he going to the liquor. And so in a discreet corner had he treated himself to his toxic cocktails. A patient ending up dead drunk in the ward was a sight that really worked me up and did so to the point that it was the only incident in a very long time that the flat of my palm had the opportunity of encountering the ill prepared cheek of another man (not the patient though).

The following morning I had gone about my business in a rather quiet and self absorbing manner. I spend a little time turning over in my head how to handle this obstinate hopeless colleague with a bad habit. He saved me the trouble himself. As I sat at the nursing station in the pediatric ward just observing the children get well along comes he seeking my indulgence. I grant him audience out of sheer curiosity and in admiration of his nerve. So the first thing he does is apologize profusely about the events of the previous night. He goes on and on beseeching me to the point of disgust and so I cut him short and ask what he wants.
Doc just give me twenty minutes I sort out an issue at the office, don't even bother to remove the canular. This is a humble request.
And so out of an ember of professional respect I give him twenty minutes to sort out an issue at the office. He never came back.

Brothers in the know, 
Battling petty and gigantic addictions.
But shall we let them go?
However the swell of their afflictions,
Shall we lose them our sight?
Seeing a brother in the know in his woes
Fills one with morbid fright..
However undoing a pact with the devil's claws
Only the brother in the know can do.