Sunday, April 08, 2012

Multiple Organ Failure – Outsourcing organs to keep a giant alive By Abimbola Lagunju

A patient with a very small head and a disproportionately large body was brought in a convoy to the International Nation-State hospital. He was unconscious. Doctors and nurses rushed to the emergency unit to attend to the new patient. Soon, word went around the hospital that a monster with a tiny head (what the doctors would later name extreme microcephaly) and a very large body had been brought into the hospital. Other nation-state patients in the hospital left their beds to see the monster. Ghana, who was about to be discharged from the hospital after being given a clean bill of health claimed to know the giant. They were once friends.

Ghana said the giant was born in 1914. The head stopped growing a few months after birth, while the body continued its normal growth. As the anomalous proportions became evident over the years, the monster became a laughing stock of everyone, including children, who at any opportunity, anywhere in the world gleefully threw stones at him. Interestingly, despite having several mirrors, the giant never looked at his own face. He did not know the size of his head. His mirrors were placed in such a way to reflect the enormous body only and the sheer size pleased him immensely. In times gone by, he used to call himself the giant of Africa. The giant only saw in sizes. The bigger, the better: Big political parties, big delegations, big agbadas, big cars, large convoys, big wives. Big life. Quality or substance was alien to the giant. He was only obsessed with extra-large sizes of everything.

The patient was rushed to the intensive unit and put on life support system. The doctors soon began a close examination of the patient and ordered for different laboratory investigations. They were all fascinated by the pint-sized head and the Goliath-sized body. The head was x-rayed. The radiologist looked at the x-ray film, cursed in his native language and beckoned to the other doctors to come over to look at the film. They were all shocked. “Not possible!” One senior doctor said. “Must be a mistake. Repeat the process,” another advised. The radiologist took a new x-ray of the head. The result was the same. There was nothing in the head. The head was empty. No blood vessels, no brain tissue. Nothing! The doctors had never seen anything like this before. They ordered for more sophisticated tests on the head – ultrasound, magnetic resonance imaging, etc. The result was the same. There was nothing in the tiny head! It was empty! How could this man have lived at all?

The heart was also subjected to tests. The doctors were again baffled. The heart was different from any heart they had ever seen – either in clinical practice or as students practicing on mammals. There is no such heart in the animal kingdom. The heart was a piece of rough hollow rock with some liquid that later tested to be crude oil inside it. It had no links with any of the vital organs in the body. No blood vessels. No sign of life. They checked the entire body organs one after the other. The organs had all failed. To the surprise of these doctors, all the laboratory tests to ascertain the causes of failure of the organs came back with the same results irrespective of the organ – corruption, outright theft, nepotism, self-destruction, abuse of office, cannibalism and violence.

Doctors all over the world are known for their indecipherable scribbling and their love for complicated terms and acronyms. The case is not different in the Nation-State Hospital where the monster was on life-support system. The doctors gave new names to the failed organs and tissues in his body and described their causes of failure. As a rule, the hospital assigns names of state agencies and organs of governance to body organs. In the case of this patient, the stomach became the National Assembly; the lungs became the NNPC; PHCN for the eyes; the liver was christened the executive council; the gall bladder became the Police, the large intestine was christened the judiciary, the pancreas became the parastatals and the kidneys christened the water corporation.

The doctors had to decide whether to let the giant die or to try their best to get him back on his large feet. They chose the latter. They had no right to switch off the life support system without the consent of the relatives of the patient.

A United Nations international conference of experts was convened to discuss the unusual case and to decide on the procedures to manage the patient and bring him back to life. All the doctors agreed that the patient would need multiple organ transplants. And not only that, he would also need state of the art immuno-suppressants in order not to reject the transplants.

There was a long debate on which organ to transplant first – brain tissue, heart or other organs. The doctors were fully aware of the virulence of the body organs against each other and the danger they could collectively pose to the survival of the giant.  Finally they all agreed to do a brain transplant. But they were confronted with the problem of the size of the head. How would they fit a normal brain into the small head? Should they relieve the monster of its tiny head and put another one with normal brain in its place. This would be an easier procedure than trying to fit a normal brain into the tiny head. But they considered the problem of recognition and identity. The monster’s relatives and friends would not recognize him if they gave him a new head. They decided to trim a normal brain and fit it into the tiny head. Their reasoning was that half a brain is better than no brain at all.

The doctors began a diligent search for the relatives of the giant to donate some organs in order to keep him alive. When the relatives learnt of this, they all disappeared. No one wanted to donate his brain or any of his organs. But it was all a procedural ruse. The doctors were not really interested in the organs of the relatives. They knew that such organs would be immediately attacked by the other organs and would again end up failing. And there was the problem of hereditary keyed-in failure in the organs of the relatives too. The failed organs have to be outsourced.

Failed local organs have to be removed and replaced very urgently in order for this giant to survive. The police, the judiciary, the parastatals, NNPC, PHCN, the National Assembly and other organs have to be out-sourced in the international market.

But who will donate the brain?

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