When Anisa walked into labor ward, she knew from the number of ambulances parked in the bay that it was going to be one of those nights. The kind where you felt like you were locked in a pressure cooker and could only let the steam out once the shift was done. What she didn’t know, was that she would have a choice to make. Her or her patient. Like many doctors, she chose her patient. And then she collapsed.
******
Dr. Anisa Mburu, who for the sake of this article we will call Nissi, is a lover of animals. At the time of this interview she had nine cats. Or perhaps it was one cat that had lived nine lives. Who knows? It is said for the nine lives of a cat, three are for playing, three are for straying and three are for staying. Nissi’s life has not been any different.
She was born and raised a Christian. Specifically a Protestant. A path she walked for years involving herself in Christian groups where she would sing, dance and act to spread the gospel.
After completing high school, she joined a group called Life Ministries and was in training to be a Youth Leader. Part of which included, attending Bible College to learn about different religions.
When it came to Islam, the facilitator would punctuate his descriptions with “Terrorists!” pronouncing the letter T with pious enthusiasm. So much so until Nissi would feel like there were only two groups of people in this world: Good people and Muslims.
Her perception was so altered, her heart would collapse and expand every time she passed a certain mosque on her way home. Initially she would not even divert her gaze to look at it, but because Nissi is a cat girl and curiosity is the meal of cats, she started to turn her eyes towards it. To see the ‘faces of evil.’
What started as a glimpse soon became a gaze and then a linger. One day, during Ramadan, a lady who was seated at the gate of the Mosque, caught her staring and beckoned her over, “Come. Eat with us.” An invisible force drew her in and she followed and sat with them. No fangs, no horns on their heads, no tails. They were normal human beings. Kind even. And it is from them that she started to get a glimpse into what Islam was really about. And her hand touched the knob.
But let’s go back to the day Nissi collapsed.
It wasn’t out of fatigue. Even if she had been as busy as a funeral home fan in summer. It was while she was doing a Caesarean section that a sharp pain gripped her lower abdomen.
“Ow!” she bent over suddenly, while extracting the baby from its comfort zone. Once the baby was out, the patient’s uterus coughed out some blood. And so did hers. Nissi felt the unmistakable warmth of something wet in between her legs.
She did the quick math in her head; it would take about half an hour to stitch everything back together. ‘Ok Nissi. Finish this case as quickly as you can then sort yourself,’ she told herself. ‘In any case, who will you call to come at this time? And the time they take to come will be the same as if you just went ahead.’ She braced herself and started stitching the uterus. It all took conscious effort, as if she was controlling her limbs from outside her body — a puppet master and a puppet at the same time. It was a race against time. Or against blood.
When she got to the skin, the assistant nurse asked her, “Doc why are you sweating so much?”
“Can you, erm,” Nissi blinked, her words lost from her, “can you close the sk…” And it’s as if someone jerked her backwards violently, because she just fell and everything went black.
**********
Nissi was and still is a why girl. She does not just accept anything because someone said. This asking is what drew her into the mosque that day and later through a web of religions.
It started when she was thrown out of her church for demonizing the youth by teaching them about Christian hip hop. She left and slid into the Catholic church. Did a stint there but couldn’t agree with some of their doctrines. Or maybe it was the kneel, stand routine that outsiders can never get right. Then she dove into the SDA church. And went straight for the extreme end of it. Started eating soya, observing the Sabbath and so on. But the whole abstinence from work from Friday evening through Saturday didn’t amuse her. She left. And stopped believing altogether. Where was this God? Why was He hiding? Or is it her who couldn’t be found?
After going the whole nine yards, and feeling constipated by religious doctrine, she converted to Islam. And stayed.
“It’s been ten years now.” She said during our call.
“How did you move from being in Bible school to being Muslim? Was there some conflict within you?” I asked her.
“Yes there was. I wondered whether I was doing the right thing. But what kept me there was a peace I had not experienced before.”
Most people who knew her said, “That’s Anisa for you. It’s a phase, it will pass.”
Well, a name change and a hijab on her head later, she hasn’t gone back.
That is how she came to be known as Anisa — meaning grace, pleasant companion, faithful friend. I could tell you what her birth name was but isn’t it more fun to guess in the comments? Here is a hint: It ends with an ‘e.’
But enough about names and religion for a bit. Remember she had passed out?
Nissi couldn’t tell how long she had been unconscious. But when she came to, there were several eyes, arranged in a circle watching her.
“What happened?” She scanned her environment.
“Doc. You fainted.” A lady who was rubbing her back responded. She said it so softly as if she was worried Nissi would faint again.
And then it hit her. The reason she had lost consciousness. And she tasted saltwater seeping out of her eyes.
Nissi was not a guest to reproductive health issues. Not those of her patients. Hers.
From when her period started, at the age of 12, she had known terrible pain. That ‘time of the month’ for her was more like that ‘pain of the month.’ Her folks at the time were focused on keeping her and her siblings alive and getting them through school. Period pain did not feature high in the hierarchy of needs in their house.
“We all passed through it,” she was told. Or, “you are a woman now.”
In her 12 year old mind that read that, being a woman equals pain and suffering. What joy was there then in being one? Yet that is the burden she carried for years until she got married.
When she and her husband tried to conceive, it was like riding a bicycle backwards. “We tried and tried. Tests, then drugs, then more tests and nothing.” But because the art of conception likes to occur in oblivion, when she gave up on trying, she got pregnant.
A difficult pregnancy. Her insides turned themselves out so much so that both she and the baby were underweight. Even if the delivery was ok, the baby had to be in nursery because he was small for his age.
By the time she was being discharged, she could barely look up. The doctor told her, “I will prescribe some progesterone pills for you for family planning ok?”
Nod.
Exactly three months later, she was pregnant.
Because who remembers to swallow pills everyday in addition to breastfeeding, pumping, not sleeping, not bathing, trying to hydrate, trying to breathe….
And before she could wrap her head around it, she lost the pregnancy.
Her sense of loss was mixed with embarrassment. ‘You are a doctor surely. How did you just get pregnant?’ She beat herself up and blamed herself so much that the next thing she did was insert a long term contraception and started her Residency in gynecologic oncology.
Three years in, she took it out to try again. Nothing.
What instead happened was the return of those devilish low abdominal pains. The ones that would grip her insides in a vice and squeeze. Even taking a dump was a tall order or a long one. Depending on how you see it.
In addition, her menses were now heavy. They came with the vengeance of being missed. And would soak through her clothes every so often.
What saved her from this pain like the last time was another pregnancy.
The pregnancy that didn’t stay long enough to be named. The pregnancy that waited for a busy night shift to leave. She was busy saving another woman’s child but couldn’t save her own. Each stitch she placed on the patient’s uterus, passed through her heart even as the life of her unborn child leaked out of her.
It seems the combination of the blood loss and the fatigue was too much. That’s why she collapsed. But get this.
It was 4am and there was no one to replace her. They were short staffed.
So Nissi got up from the floor that was holding her, went to clean up, change her scrubs and came back to save the babies that needed saving. Her shift ended at 8am.
She went for an evacuation and later tried to get time off but that request was declined.
So she went back to work.
But her woes were not over.
“My menses came knocking barely a month later and if hell was a place, I was in it.”
Now the pain started to linger even after her menses. She struggled to get out of bed to go to work. Scans done would just show some cysts in her ovaries that were brushed off as unremarkable.
“To function, I had to inject myself with painkillers almost daily.” And when it became debilitating she would get admitted.
Can you imagine living in a world where all the colors you see are marred by pain? Anytime someone asks ‘Hi, how are you?’
‘Well I am in pain.’
‘How have you been?’
‘In pain.’
‘How are things?’
‘Painful.’
‘How is the baby?’
‘I can’t hold him because…’
And she could tell people were beginning to get bored of the narrative. Sometimes they would ask her questions as if they were trying to prove that it was in her head. At some point, even she thought maybe it was in her head.
Until one Friday.
Seems bad things happened to her on Fridays. And always in the operating room. This time she was gouging out a tumor from a young girl’s body when that characteristic pain gripped her. It never gave a warning or a preamble. Like thunder, it would just twist and turn her insides then release only to repeat it more severely in seconds.
“I can’t.” She let go of the instrument in her hand. “I can’t do this,” she hissed in agony. The team stared at her probably thinking she meant she couldn’t do the surgery because she didn’t know how. She was still a Fellow after all. ( You don’t know what a fellow is, do you? I will explain later, let’s keep reading) Nissi stepped back, made a call to a colleague and said, “I c.. can’t s..s..stand. I c.. can’t.” The words were stuck.
Her colleague quickly came and stepped in and Nissi left for the airport. I know you are wondering what on earth a girl in pain was going to do at the airport. But if you stopped wondering and just read, you would know.
She got into the next available flight to Mombasa. There, there was a gynecologist she had worked with back in the day when she lived there. Someone skilled who she knew would believe her. When she arrived, she called him and he said, “I am not even on duty today. But because of how you sound, I am coming.”
He came in and slowly took his time listening to her push her words out as if she was mining them. He looked at all her scans, her MRI and said, “These are not telling me much Anisa. I want to take you to the OR, put in a scope and see what we will find.”
“Do. It.” Was all she could say.
In a matter of seconds her pain was gone as she went under anesthesia.
Hours later after she awoke, groggy from the drugs, the gynecologist came to her bedside.
“Anisa we figured it out.”
She nodded to tell him to go on.
“I am sorry doc. You have stage IV Endometriosis. Those cysts in your ovaries were endometriomas. Things were a mess in your pelvis. Your uterus was stuck to your rectum and you had multiple adhesions. I tried what I could, which wasn’t much because of the bleeding but I tried what I could. Your ovaries…” he paused and almost in a whisper said, “you can’t have children anymore.”
And despite herself, Nissi smiled.
“It was not in my head after all. I had a diagnosis. Something could be done.”
And something was done. They inserted Mirena for her and started her on Visanne. And her quality of life improved remarkably.
Her physical health got better day by day. But she underestimated the hit that her mental health had taken. From the pregnancy losses to the pronouncement that she couldn’t have children anymore.
Worse still, when friends and relatives would ask, “When are you adding another one? You can’t just have one child!”
"Give your child a playmate Nissi.”
Initially she would get offended but now she just says, “I have nine cats” and they get the drift.
But the journey is still on going. She exercises both her mind and her body; guarding her mental health jealously.
She is able to apply herself fully to her work, her marriage and her son.
“I am finally ok with not having any more children. I am just happy I am no longer in pain.”
This is Dr Anisa a gyn-oncologist who now sees the world in colour.
A gyn-oncologist is a doctor who has specialized in diagnosing and treating cancers associated with the Female Reproductive Tract.
A fellowship is a period of medical training where one studies to become a sub-specialist. While Dr Anisa was doing her fellowship she was termed a Fellow. She since completed.
Endometriosis is a chronic, inflammatory disease where endometrial like tissue grows outside of the uterus.
It is mostly found in women of reproductive age.
The most common sites affected are the ovaries, the bowel, the fallopian tubes etc.
The exact cause is not known but there are several theories which have been suggested.
Symptoms include: Painful periods, pain in between periods, pain during sex, pain during defecation.
Patients with endometriosis often find it difficult to get pregnant.
Diagnosis MAY be made by ultrasound but to know for sure, laparoscopy may need to be done. (As it was in Nissi’s case)
Treatment can either be medical or surgical depending on your symptoms.