Rocket Man, The Creation of Life

An empty health clinic. Writers of Grey’s Anatomy, a job well done. You successfully dramatized a superstition. It may not even be traditional medicinal folklore; however, one out of two American households learned a slow surgical board foreshadows a 2-hour post-superbowl rating booster. Who knew a WWII rocket launched in a man’s chest cavity could threaten the lives of Seattle’s finest surgeons? I surely did not.

I arrive to work with steps of vigor and ambition. I feel as if I was about to crunch out hours of Biochemistry and Organic Chemistry. Both require a high level of liveliness and self-petition to compete with the Saturday beer barbeque babel sailing up to my window. What was the payoff? By the end I would know how the liver transformed colorless flammable organic compound into usable materials --major turn on.

I crawl out of the taxi, pat my shirt flat, take in some air and begin an uplifting gait. Today, with vigor and ambition, I would defy all odds and complete more than an hour of work. An explanation must be painted for the normative lackluster production for I would consider this atypical personal behavior. Ugandans have very little concept of time. To be culturally sound, Ugandans have a different approach to time.

To compare, an honest American day of work translates to eight hours of number crunching, Wall Street transacting, table turning, nose-to-the-grind work. An internal ribbon message repeats in our psychological framework over and over and over: Money is time and time is money.... Money is time and time is money.... Money is time and time is money. If an hour remains, it is spent at lunch and/or canoodling amongst your cohort of methodic bees. 9 hour, 5 days a week workdays can easily translate into work evenings or--if boss Jane or John deem--Saturdays of hell.

An honest Ugandan workday is the exact opposite. Time in the day is alloted in three sections: soft spoken introductions, excessive eatings and well-being conversations usually pertaining to the formers.

I have yet to participate in a full fledge introduction. My inflicted eardrums typically miss the soft spoken introductions. In fact, I am 60% sure they have no idea what is said in the exchange. Instead they intermix four phrases with exclamations to hit any possible relevant answer. Gyebala, Hmm. Kale, mm, Olyota Hmm, Gendi mm. English translation: Well done, I am not too sure. Thank-you, delicious. How are you?, I am not too sure. Fine, delicious. Women typically bow to men and young women bow to their female elders. Kinesthetic movement and my 20/20 eyesight increase the my probability of participating in introductory rituals.

The second and third sections of the day are entwined with each other.

A Conversation on Hunger

“You have breakfast?”
“Yes, my host mom fed me breakfast.”
“We cook you breakfast.”
“No, it’s alright I am not hungry. I had a HUGE---simultaneously, the puppet show begins as hands expand to either side---breakfast. I had TWO---flashy peace sign---eggs, potatoes, toast, carrots, cucumbers. It was quite delicious.”
Her head cocks to the side eyes paint a ghostly face. More than likely, the bird like arm extensions distracted verbal communication. For the cherry on top of my American ignorant sundae, I rub my tummy. “No need for more food.”
Long sigh. “I don’t get you.”
They exit the conversation, not waiting to hear another word.
“I...I...” am left speechless.

15 to 30 minutes following, I have three scoops of starch and pieces of mystery cafeteria mystery meat in front of me. Perhaps chicken. There were three in the coup yesterday, two together. I probe the specimen. Yes, chicken.
“You eat.”

A Conversation on Vegetarianism

I hesitate for moment. Should I really attempt to cross this bridge?
“I am a vegetarian.” The words slip out before reaching a thought out decisions. Word vomit.
“Huh?”
“A vegetarian.” I repeat as if defining the word. Let’s re-try, “I do not eat meat.”
“You don’t eat meat?!” Her face was of a confused, slightly angry child just told the fabrication of Santa Claus. He doesn’t exist?!
“Correct. I do not eat meat.”
She glares at the food. Mystified, she looks back at me, points at the plate. “No meat.”
“Right, I do not eat meat.”
“No, no. No meat.” She rattles the plate.
We must be looking at different plates. Plain in front of me: a dark, oozing, hunky chunk of chicken. Impossible to miss. I point: “Meat here!” I overemphasize: “chicken!”
She is unsatisfied. “Chicken is not meat. Chicken is bird.” She flaps her arms up and down. A tablet of my own medicine. I encouraged this behavior. Eyes and palm open to the coup: “You know a chicken?”
My stomach sinks. “Yes, of course, I know what a chicken is.” Nervously unsure of the result of this game of charades, I end it: “I do not eat meat, beef, chicken, bird, cow, pig, pork (now struggling to think of edible animals), mice, moose (overkill).
“Ahhhh.” Head nod. “I see.” She now understands I do not eat any animal. Eye brows drop in, nostrils flare concern. She does not understand why I do not eat animals. “I don’t get you.”
She walks away.
The chicken clucks on my plate.

After plucking and scattering the muscles strands off the bone making it less obvious I did not eat the meat, I escape to the computer room. The past hour exhausted my levels of vigor and ambition. To replenish the lost energy, I set a goal: open Microsoft Access and create database. Having never heard of the software, the goal instantly becomes quite lofty. If the future is a cyclical repetition of history, the outlook is bleak. Technology and I have a shaky past. I am too forgiving. Technology is the devil.

Day 1: Dan vs. PC Laptop
Dan: Sets up powerpoint presentation for lesson, connects computer to LCD Projector.
Technology: Works.
Dan: After two successful classes, puts technology on hibernation for lunch break.
Technology: Sleeps.
Dan: Bell rings, shakes technology up. Students enter.
Technology: Computer dies.
Dan: Screwed.

Technology-1, Dan-0

Day 2: Dan vs. LCD Apple converter
Dan: Buys new computer.
Technology: Works.
Dan: After two successful classes, puts technology on hibernation for lunch break.
Technology: Sleeps.
Dan: Bell rings, shakes technology up. Students enter.
Technology: LCD connection dies.
Dan: Screwed.

Technology-2, Dan-0

Day 3: Dan vs. MacBook
Dan: Buys new LCD connector.
Technology: Works.
Dan: After two successful classes, eats lunch with technology.
Technology: Works.
Dan: After three successful classes, leaves to go to office, comes back to class.
Technology: Cracked, bleeding screen.
Dan: Screwed.

Technology is the devil.

Motivation, ambition and positivity muster movement to the computer room door.

Turn the knob,
push the door,
flick the light,
lights on,
breathe in.

Step into room.
Light flicks,
look up.
Lights off,
Power outage.

I turn and glance at the COWESER property, not a person in sight, dead and dusty land. I smell failure on the day. While thinking of my next steps, my feet coerce me to an empty clinic. My morning rounds saw a toddler with malaria leave the clinic healthy--a success.

As I am approaching the clinic hall, a young boy and his mother enter ten meters ahead. Ten bucks on malaria. I pass by the patient check in room, peek through the door crack to find the same pair. The boy’s toes rhythmically and anxiously bounce up and down. When in his shoes I disliked the doctor’s office as well. The sugar sucker is never worth the needle piercing my muscle. COWESER has no sugar suckers. He had his head down, one hand between his bone-thin thighs, the other lightly stroking the brilliantly pink scarf wrapped around his head.

The scarf instantly reminds me of my sister. She would love that scarf. When she was a young toddler, mercilessly screaming at the world, my parents would bring her to the pink tile scaffolded bathroom. Pink threw up in it and my sister soaked it up. She would always stop crying in the bathroom, she took comfort in shade of pink. This boy wrestles to find tranquility in his pink scarf.

The mother’s eyes catch mine. Caught, my muscles freeze, unsure of her reaction to my probing eyes. I offer a non-threatening smile. She hesitates then smiles lightly, slightly dipping her head in. Her eyes return to mine. My smile turns to a grin, eyes soften as I bow my head slightly and return to her eyes. A brief, but true bond of human acceptance blind to race, sex, and culture. Connection. A warm feeling emanates from my core as I desperately grasp this moment of purity. She continues her discussion with the nurse.

I zip to the nurse preparation room. Eve, a third year nursing student who has an crush on me, explodes with news. At COWESER, I have spent the most time with Eve. Unfortunately, her English is poor and most of our time is exhaustingly spent in attempts of communication. She blurts out, “Circumcision!” My eyes widen as her smile grows. I know the word. No wonder the boy was grasping into his scarf.

Two Conversations on Circumcision

One:
“Is the boy getting a circumcision?”
She looks at me with her mouth open not knowing I just asked a question.
Charades begins. “The boy.” Rapidly jerks finger to the check-in room. “Circumcision.” I tuck my arm into my sleeve, my free hand acting as scissors cuts the foreskin of my model.
She giggles and repeats my gesture. Her eyes widen, head nods up, “Ya.”
“Are you in the procedure?”
Blank stare.
Give me a break.
“You.” Point to her. My shirt model reappears. “Do the cutting.”
She giggles and repeats my gesture. Her eyes widen, head nods up, “Ya.”
Aside, “Oh, wow that is going to be fun.”
“Wha?”
I redirect the statement at her “Gives you something fun to do.”
“Wha?”
“It is pretty dead around....,” face of confusion, “...forget it.”
“Wha?”
“Forget it.” I wave my hands motioning an X and shake my head. She takes amusement in my hand gestures.

Two:
Dr. Sam, the resident doctor, enters smiling.
I break the silence, “So a circumcision today, huh?”
“Yea, you handle blood?”
Startled and puzzled by his question, “uh, I think so...”
“First time I saw blood, I feared it. Now it doesn’t bother me.”
“So, how long is this procedure?”
“About 15 minutes.”
“Not bad.” It was at this point that I had absolutely no idea what an actual circumcision entailed. I had visions off a contraption similar to a cigar cutter and clipping the edge of a cigar, a miniature guillotine. A quick snip, quick stitch. My body shivered.
“How long will it take the little guy to recover.” I point to the check-in room.
Dr. Sam giggles at my question. “I will check the little guy in 10-14 days.” I unknowingly created a penis joke. Great. Thoroughly embarrassed, I bid Eve and Dr. Sam farewell and head back to my lightless computer room.

Sitting and staring at the computer my heart surges. Is he asking me to join him? Am I really going to watch a circumcision? Could I handle the blood? Visions of one of my students passing out in the middle of the class while discussing the contents of blood overwhelm my mind. I have no interest in losing consciousness. A nurse breaks my thoughts. “Dan, the circumcision!”
“Ya, and...”
She grasps my arm. “Come. Come, quickly.”
I stare at her death grab. A frog croaks in my throat. This nauseatingly familiar frog always prevented me from successful slumber parties. There is no going home today. I jump from my seat and follow her to the clinic. Answers to my concerning questions would unfold in the next 15 minutes.

My guide ushers me to the surgical theatre. My adrenaline pumps. My extremities tingle. Stop. Although meant figuratively, a flash of pink crosses my path, I physically stop and stare into the nurse holding room. I see the boy’s scarf hanging on a peg. Looking further, I see the little boy laying on the table. The head nurse is tending to lacerations an inch above his right eye. She threads through his facial skin and pulls tight.

Suddenly I find myself, about the same age as the boy laying down on cold table. I am blinded by the bright light above me. The outline of a curly black haired man tells me we are almost done. A tear crawls down my cheek as I fall into dreams. Wait. Was not he the patient undergoing a circumcision? Who is getting the circumcision? What else did Eve not...?
“Dan!” Eve exclaimed. Back to reality.
“Dan, come put this on.” She spins and dresses me in a white coat. “You need to wear this coat before you go in.”
“Where is your coat?”
“I cannot go.”
“What? Why? Eve who is getting a circum...” She pushes me into the door and turns the knob.

The room jumps as one. Dr. Sam lunges forward to cover the patient, all eyes fire at me. I turn pale and light headed. My sense of sound proliferates. I swallow waiting for someone to make a move. The room stands painstaking still for 5 seconds, feels like a day. Door hits me in the butt.
“We thought it was one of the girls,” one of the male nurses calls. Muscles relax and the doctor uncovers the patient.
In the room there are others: Dr. Sam, two male nursing students and a man in his 30s.
“Women are not allowed?” I half heartily reply.
The patient’s fierce eyebrows throw me back.
The doctor replies, “This patient is a man. No women allowed.” As he finished his short explanation, he lays the patient down simultaneously calming him, unbuttons a portion of the plastic green blanket and exposes the man’s penis.
The doctor explains the procedure piece by piece to the patient and the nurses. Following, he looks at me and repeats his steps in English.

Steps to Dr. Sam’s Circumcision
Inject in between the skin and tissue of the penis with local anesthetic at varies points.
-The nurse injects. Failure. Dr. Sam, annoyed, steals in the needle and injects the patient himself.
*The patient squeals as he watches the nurse ineffectively numb his penis. He starts speaking in a nervous tone to the surgical team. He glances at me to receive empathy.
^My thoughts are racing. I wince at the patient’s squeal and instantly show facial expressions of empathy. I am so glad I had this done at birth.

Squeeze the penis from the base up to check numbness.
-Doctor squeezes.
*Patient nods.
^I gulp.

Place your index and middle fingers together at the base of the corona. Use razor make a thin circumference cut at the below lower finger.
-Doctor places his fingers and cuts accordingly. This serves as a baseline.
*The patient watches on with intrigue.
^I discover my index-middle finger combination is much thinner than the doctor’s and wonder the significance.

Using scissors, start at the tip of the foreskin and begin to cut down to the base of the penis.
-Doctor begins his incision while instructing the nurse to hold the penis up for support. He makes an attempt at the initial cut. Fail. A fly gets in his view, swat. It takes the doctor makes several attempts before the skin breaks. He cuts down the foreskin to the base of the corona.
*Patient looks up at the ceiling unable to watch the initial cut, nervous of the effectiveness of the anesthesia. He lets out a sigh of relief as he hears the splitting foreskin. He continues to watch.
^I see blood. Have a passed out? Does the patient feel it? Is this a fly? Are the windows supposed to be open? Are those scissors sharp? What’s next?

Fold the foreskin over and make an incision at the base of the corona.
-Doctor instructs nurse to fold back the foreskin. He makes cut at the base of the corona. His hand flinches slightly as he looks at the patient. The nurse takes more local anesthetic and injects at the base of corona. Doctor cautiously reattempts his cut.
*Patient screams in pain. “Ssebo, Ssebo, Ssebo!” sir, sir, sir. His eyes roll to the back of head and he lays his head back down and expels a burst of oxygen.
^My eyes dart to the patient’s pain of anguish. Shock, what? I involuntarily hold my breath.

Cut down to and then around razor baseline.
-Doctor works his scissors down to the baseline. Doctor adjusts places one hand on the top hole of the scissors and the the second in the second. Unhappy of his positioning, he switches locations with the nurse and positions his hands around the scissors again. Sweat pouring down his cheek, his breathing rate increases as success of cutting through the skin fluctuates.
*Patient rejoins the surgery watching his skin poorly slicing in two.
^Early in October, I spent a day teaching students how to create a foldable study guide. The outcome of the foldable is strictly dependent on your ability to neatly fold and cleanly cut. To my dismay, their scissor manipulative skills ran congruently with their low reading ability. For an unfortunate few, this was the beginning of a short lived relationship between hand and scissor. Watching the doctor ply through this man’s skin mirrored poor Miles cutting through paper.

Starting from the base, peel skin off remaining tissue, clean off tissue and search for severed blood vessels, suture when necessary.
-Doctor places his scissors down and wipes the beads of water from his forehead. He instructs the nurse to simultaneously hold the base and corona of the penis. He turns to the patient and asks a question in Lugandan. He peels back the skin, exposing the bloody tissue. The doctor turns to me, “He is married with 8 children.” The nurse applies cotton balls to the gooey bloody mess. He clamps severed blood vessels. The doctor sutures.
*Patient answers doctor. His eyes and mouth slowly enlarge as he watches the doctor peel away his skin exposing his bare penis. His faces freezes.
^8 kids. Huh, does anyone follow family planning in this...” Holy hell! He just skinned the penis. Oddly enough, the corona looks as if he has a red cape. What would its hero name be? Rocket Man. Superpower? Creation of life.

Cut around the base of the corona and remove skin.
Doctor jaggedly cuts the skin, removes the skin and plops it in the pool of blood below the penis. The nurse cleans and continues on his search for severed blood vessels.
*Patient’s face returns to normal. He lays back down and looks up at the ceiling.
^Pigs in a blanket, a delicious super bowl snack. If you wrapped a normal hot dog in a croissant, held it like corn-on-the-cob, ate away the middle part leaving croissant on either end, and saturated the exposed hot dog with ketchup you may come close to the image burning in my memory.

Pull up the skin at the base of the penis and make several sutures attaching to the skin at the base of the corona.
-Doctor attaches the skins with first suture, second suture, third suture, fourth suture, fifth! The doctor and nurse sharply look at the patient. “I need to put in at least 3 more sutures. I am sorry we have no more anesthetic. He slowly threads the needle through the skin, pauses, slowly threads again, pulls tight and knot. Twice more.
*Patient’s thoracic cavity launches forward. “Ssebo, Ssebo, Ssebo!!!” Distressing eyes, he did not like the doctor’s reply. He clinches his teeth and air sucks in and out.
^Almost done. The penis takes normal shape again. I jump. I am one of the jumpiest people. I become so involved in what is happening in front of me that any slight deviance causes such a shocking uprise--an inconvenient habit. There is no more anesthesia? Can that really just happen? Oh, Uganda.

As the man pulls up his pants, the doctor and nurse clean the surrounding area. The nurse wipes the table of blood with the cover sheet and the doctor collects all the metal tools. The nurse leaves the theatre with the sheet and metal tools in hand. The doctor walks over the patient.

“Do you have the balance?” the doctor asks.
Man pulls out schillings and replies, “We agreed upon 40,000 Ugandan schillings. Here is 20,000 now and then remaining will be given at the check up.”
“Hmmm.” Slightly disgruntled, the doctor accepts the cash.

*Note: The original conversation was in Lugandan. The doctor translated per my request after the patient left the theatre.

40,000 Lugandan shillings roughly converts to $20 US. Twenty bucks for Rocket Man to loss his cape. To paraphrase the sassy super hero fashion designer spawned from Vera Wang in The Incredibles, many super heroes have died because of their capes. One became a victim on a plane engine and another a victim of tripping. Capes are a safety hazard.

There is a growing trend of circumcisions in older men and male newborns in Uganda. For the young, spilling the blood contaminates their purity. This prevent them from becoming victims of theft and subsequent cutlery. When one of the main highways was built between Masaka and Kampala, local witch doctors prescribed pure baby blood for the project’s success. My brother laughed as he described the sudden drop of infant population during the project. “So many baby pieces underneath the pavement!”

The rise of circumcisions in older men is a result growing support in the positive correlation between contracting HIV and foreskin. My internet access is too slow to research references; so, at this point I can only take their word. The cartoon fashionista seemed to know her stuff: capes = death.

I left the surgical theatre repeatedly replaying and reprocessing the previous 20 minutes. How is it done in the US? was the only thing that came to mind (it competed with the hotdog image). Perhaps tools would be sharper, local anesthetic in full stock, no winged insects interruptions, closed/windowless rooms, antiseptics. Maybe I am making too many assumptions.

I passed into a buzzing ward, among several new patients being escorted to their rooms, followed by a steady stream of family members. Ten bucks on malaria. I cracked a smile. The world around seemed to move a little bit slower. The ward was in full operation. I walked down the corridor reenergized, ambition and vigor revived.

Maybe Grey’s Anatomy writers were correct... minus the WWII rocket...