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.