Monet stared redly at Dr. Musoke, but there was no movement in the eyeballs, and the pupils were dilated. Brain damage: nobody home. His nose was bloody and his mouth was bloody. Dr. Musoke tilted the patient’s head back to open the airway so that he could insert the laryngoscope. He was not wearing rubber gloves. He ran his finger around the patient’s tongue to clear the mouth of debris, sweeping out mucus and blood. His hands became greasy with black curd. The patient smelled of vomit and blood, but this was nothing new to Dr. Musoke, and he concentrated on his work. He leaned down until his face was a few inches away from Monet’s face, and he looked into Monet’s mouth in order to judge the position of the scope. Then he slid the scope over Monet’s tongue and pushed the tongue out of the way so that he could see down the airway past the epiglottis, a dark hole leading inward to the lungs. He pushed the scope into the hole, peering into the instrument. Monet suddenly jerked and thrashed.
Monet vomited.
The black vomit blew up around the scope and out of Monet’s mouth. Black-and-red fluid spewed into the air, showering down over Dr. Musoke. It struck him in the eyes. It splattered over his white coat and down his chest, marking him with strings of red slime dappled with dark flecks. It landed in his mouth.
He repositioned his patient’s head and swept the blood out of the patient’s mouth with his fingers. The blood had covered Dr. Musoke’s hands, wrists and forearms. It had gone everywhere—all over the gurney, all over Dr. Musoke, all over the floor. The nurses in the intensive care unit couldn’t believe their eyes, and they hovered in the background, not knowing quite what to do. Dr. Musoke peered down into the airway and pushed the scope deeper into the lungs. He saw that the airways were bloody.
Air rasped into the man’s lungs. The patient had began to breathe again. The patient was apparently in shock from loss of blood. He had lost so much blood that he was becoming dehydrated. The blood had come out of practically every opening in his body. There wasn’t enough blood left to maintain circulation, so his heartbeat was very sluggish, and blood pressure was dropping toward zero. He needed a blood transfusion.
A nurse brought a bag of whole blood. Dr. Musoke hooked the bag on a stand an inserted the needled into the patient’s arm. There was something wrong with the patient’s veins; his blood poured out around the needle. Dr. Musoke tried again, putting the needle into another place in the patient’s arm and probing for the vein. Failure. More blood poured out. At every place in the patient’s arm where he stuck the needle, the vein broke apart like cooked macaroni and spilled blood, and the blood ran from the punctures down the patient’s arm and wouldn’t coagulate. Dr. Musoke abandoned his efforts to give his patient a blood transfusion for fear that the patient would bleed to death out of the small hole in his arm. The patient continued to bleed from the bowels, and these hemorrhages were now as black as pitch.
Monet’s coma deepened, and he never regained consciousness. He died in the intensive care unit in the early hours of the morning. Dr. Musoke stayed by his bedside the whole time.
They has no idea what had killed him. It was unexplained death. They opened him up for an autopsy and found that his kidneys were destroyed and that his liver was dead. His liver had ceased functioning several days before he died. It was yellow, and parts of it had liquefied—it looked like the liver of a three-day-old cadaver. It was as if Monet had become a corpse before his death. Sloughing of the gut, in which the intestinal ling comes off, is another effect that is ordinarily seen in a corpse that is days old. What, exactly, was the cause of death?
It was impossible to say because there were too many possible causes. Everything had gone wrong inside this man, absolutely everything, any one of which could have been fataclass="underline" the clotting, the massive hemorrhages, the liver turned into pudding, the intestines full of blood. Lacking words, categories, or language to describe what had happened, they called it, finally, a case of “fulminating liver failure”. His remain were placed in a waterproof bag and, according to one account, buried locally. When I visited Nairobi, years later, no one remembered where the grave was.
1980 January 24
Nine days after the patient vomited into Dr. Shem Musoke’s eyes and mouth, Musoke developed an aching sensation in his back. He was not prone to backaches—really, he had never had a serious backache, but he was approaching thirty, and it occurred to him that he was getting into the time of life when some men begin to get bad backs. He had been driving himself hard these past few weeks. He had been up all night with a patient who had heart problems, and then, the following night, he had been up most of the night with that Frenchman with hemorrhages who ha come from somewhere upcountry. So he had been going nonstop for days without sleep.
He hadn’t thought much about the vomiting incident, and when the ache began to spread through his body, he still didn’t think about it. Then, when he looked in a mirror, he noticed that his eyes were turning red.
Red eyes—he began to wonder if he had malaria. He had a fever now, so certainly he had some kind of infection. The backache had spread until all the muscles in his body ached badly. He started taking malaria pills, but they didn’t do any good, so he asked one of the nurses to give him an injection of an antimalarial drug.
The nurse gave it to him in the muscle of his arm. The pain of the injection was very, very bad. He had never felt such pain from a shot; it was abnormal and memorable. He wondered why a simple shot would give him this kind of pain. Then he developed abdominal pain, and that made him think that he might have typhoid fever, so he gave himself a course of antibiotic pills, but that had no effect on his illness. Meanwhile, his patients needed him, and he continued to work at the hospital. The pain in his stomach and in his muscles grew unbearable, and he developed jaundice.
Unable to diagnose himself, in severe pain, and unable to continue with his work, he presented himself to Dr. Antonia Bagshawe, a physician at Nairobi Hospital. She examined him, observed his fever, his red eyes, his jaundice, his abdominal pain, and came up with nothing definite, but wondered if he had gallstones or a liver abscess. A gall-bladder attack or a liver abscess could cause fever and jaundice and abdominal pain—the red eyes she could not explain—and she ordered an ultrasound examination of his liver. She studied the images of his liver and saw that it was enlarged, but, other than that, she could see nothing unusual. By this time, he was very sick, and they put him in a private room with nurses attending him around the clock. His face set itself into an expressionless mask.
This possible gallstone attack could be fatal. Dr. Bagshawe recommended that Dr. Musoke have exploratory surgery. He was opened up in the main operating theater at Nairobi Hospital by a team of surgeons headed by Dr. Imre Lofler. They made an incision over his liver and pulled back the abdominal muscles. What they found inside Musoke was eerie and disturbing, and they could not explain it. His liver was swollen and red and did not look healthy, but they could not find any sign of gallstones. Meanwhile, he would not stop bleeding. Any surgical procedure will cut through blood vessels, and the cut vessels will ooze for a while and then clot up, or if the oozing continues, the surgeon will put dabs of gel foam on them to stop the bleeding. Musoke’s blood vessels would not stop oozing—his blood would not clot. It was as if he had become a hemophiliac. They dabbed gel foam all over his liver, and the blood cam through the foam. He leaked blood like a sponge. They had to suction off a lot of blood, but as they pumped it out, the incision filled up again. It was like digging a hole below the water table; it fills up as fast as you pump it out. One of the surgeons would later tell people that the team had been “up to the elbows in blood”. They cut a wedge out of his liver—a liver biopsy—and dropped the wedge into a bottle of pickling fluid and closed up Musoke as quickly as they could.