Author: Nanadadzie Ghansah

Sprouting

It’s a cycle…as some die, others are born…as one takes the last breath, somewhere else a mother hears the first cry…as some are withering, others are…

“Sprouting”
A Wet plate collodion image

The Reflection

In the fading glow of the setting sun, he watched as it appeared on the shimmering surface of the lake….the contours, lines, and curves ….the tones thrown off by the ever-undulating ripples…

“The Reflection”

 

An Audience with the Father

After several months of pleading, I was granted an audience. I don’t even know how I got there but all of sudden, I found myself before this large, rather ornate gate. As I looked around, the gate opened as if by remote control. The mansion that was revealed was breath-taking. It arose from the carefully manicured grounds like a symphony from an orchestra.
I walked along the only pathway visible. It was marble! As I walked, I marveled at the landscaping. How expensive it must be to keep that, I thought. The pathway brought me to a massive wooden door. Just as I was about to open it, it swung open. Standing in the doorway was an old man with flowing white hair and a white beard. He beckoned me in. He introduced himself as Peter and asked me to follow him.
Words cannot describe the beauty of the decorations, paintings and statues that graced the mansion. Soon we came to another door and this one opened by itself too. It revealed a large hall. At one end sat a throne.
Peter turned to me and said, “He will be out soon. Sit in that chair and wait. Once he appears, you have thirty minutes. Good luck.”
He turned and walked off even as the door swung shut behind him.
Then I heard a voice go, “Nanadadzie my son, how can I help you?”
I spun around to see an imposing figure sitting in the throne.
Somehow, around him was a certain glow. His face was lit by a broad smile that illuminated the lines of wisdom that gave his face such depth of character. His eyes were deep and seemed to hold a lot of something. I couldn’t put my finger on it.
“Nanadadzie, you have 30 minutes. Use that time well”, he continued.
“Are you God?”, I asked.
“The One and Only”, he answered.
“Where is Allah? I wanted to meet both of you”, I asked.
“I am One and the Same”, he pointed out.
“May I call you just God or Dear God”, I asked.
“Call me Father”, he said.
“Father, do you know the mess going on down there on Earth in your name?”, I asked.
“I know, Nana, I know. It’s OK to call you Nana, right? Most people call you that”, he said.
“Of course you can, Father”, I answered. “So you know there’s a lot of bad things being done in your name and you are fine with that?”, I continued, incredulous.
“Nana, they use my name in vain to do these bad things”, he answered.
“So why do you allow that?”, I asked.
“You humans have free will, you know that right?”, he asked me.
“Father, free will to use your name for the Crusades? The numerous European religious wars? Slavery? Apartheid? Al-Queda? ISIS?”, I asked.
“Nana, the human ultimately has to discover the Truth”, he said.
“But, but the carnage is great. Did you see Brussels? And Paris? Have you seen what Boko Haram is doing in Nigeria? The attacks in Mali, Bukina and Cote d’Ivoire? The beheadings in Syria? Syria? Iraq? 9-11? What truth do you find from such carnage? That religion leads to violence?”, I asked, my voice rising.
“Nana my son, I could with a stroke of my finger, wipe all out. What lesson would that teach mankind?”, he asked.
“That you cannot mess with God. You did that back in the day!”, I volunteered.
“I might have but did it teach mankind anything?”, he asked, looking at me sternly.
“So we have to go through all this pain to learn? To learn what?”, I asked.
“To learn to live together as one”, he replied.
“Father, call me cynical but that isn’t happening. The Church you left down there is in shambles. You heard of all those priests and the kids, right? That was a disaster. Islam has been hijacked. The races hate each other. There are wars everywhere. Large swaths of the population is starving or dying from diseases. And we are supposed to live together as one? I’m sorry but I have no faith that will ever happen”, I declared.
“Nana, do you believe in me?”, he asked.
“Father, to be honest, there are lots of times that I have my doubts”, I offered.
“Nana, you are bound by time and space. I see eternity. Good always overcomes evil. The right shall dominate the wrong”, he said.
“You sound like my late dad. By the way, is he around?”, I asked.
“Yes he is but he is not the reason you are here”, he replied then continued:
“There is always a dark side to light. A bitter side to the sweet. Those who use my name for evil are the dark side of light. Ultimately, the light shines so bright, the darkness is unseen and unheard. Believe and be strong”, he said.
Suddenly, I heard a sound behind me. I turned to see Peter in the doorway.
“It is time”, he said.
I swung around to ask God a last question but the throne was empty.
I sighed and walked out of the hall behind Peter. With each step, I heard a ringing sound. As we neared the main door, it got louder. The minute he opened the main door, the piercing scream of my alarm broke through, waking me up to another morning of life on this Earth with it’s violence, pain and hopelessness. Or is all that leading to a time of peace, love and hope?
That is when it hit me. What I had seen in his eyes. His eyes were full of certainty. Certainty that all will be well. That good will overcome evil. That the right will dominate the wrong. Certainty.
I sat at the edge of my bed and realized that I wasn’t so certain. That good will overcome evil. That the right will dominate. I wasn’t at all but wished I had faith. Wished I believed. I didn’t.
I sighed.

The Healing of a Nation

“That is not a drug, it’s a leaf.”
– Arnold Schwarzenegger

In the next few years, two of the many areas that could be interesting areas of medical research and therapy may be the the fields of cancer immunotherapy and the medical use of cannabinoids. Yes, cannabinoids – those extracts from cannabis aka marijuana aka weed!

No other plant is as controversial as Cannabis. In spite of an almost 5000 year-old history of use around the world, it has been a banned substance in most countries in the last 100 years or so.

It’s ill-repute stems from it’s psychoactive effects which can be significant.
Some of the chemicals inherent in the most common species of this plant, Cannabis sativa, have been isolated and they are called cannabinoids. There are about 85 of them. The two most researched are:

– Delta-9 Tetrahydrocannabinol (THC) and
– Cannabinol (CBD)

Whereas THC is responsible for most of the psychoactive effects (the high), CBD has none of the high effect. Both cannabinoids have some very significant therapeutic effects.

THC – analgesic, anti-spasmodic, anti-tremor, anti-inflammatory, appetite stimulant and anti-emetic
CBD – anti-inflammatory, anti-convulsant, anti-psychotic, anti-oxidant, neuroprotective and immunomodulatory effects

Even more interesting is that the human body has cannabinoid receptors. This has been an area of research for the last 20 years or so. Two types of cannabinoid receptors have been found so far – CB1 and CB2. CB1 receptors are present in the brain and spinal cord and in certain peripheral tissues. CB2 receptors are expressed primarily in immune tissues.
Now if the body has cannabinoid receptors, then humans must produce natural cannabinoids. At least 3 have been isolated so far – arachidonoyl-ethanolamide (anandamide), 2-arachidonoyl glycerol (2-AG) and arachidonyl glyceryl ether (noladin ether).

These endocannabinoids are involved in areas of the brain responsible for:
– movement and postural control, pain and sensory perception, memory, cognition, emotion,
control and reward centers in the brain (limbic system and hypothalamus)
– cytokine release from immune cells and immune cell migration

So when one uses marijuana, do the cannabinoids from the weed react with the natural receptors? That is the thought and that is how they exert their action.

The push is then for strains of Cannabis high in CBD to capture the medicinal sans psychoactive effects. This is achieved by altering the genome of the cannabis plant to get strains that contain mostly CBD. An example of a strain with high levels of CBD is Charlotte’s Web.

In the forefront for drugs made out of CBD is GW Pharma, a company out of the London, UK. They have a drug out named Epidiolex for Dravet Syndrom. This a condition marked by intractable seizures in kids. These kids can have over 20 seizure a month. It reduced the incidence of seizures in a study of 120 children by close to 40%. FDA approval is pending.

CBD-based drugs are also being studied for Multiple Sclerosis. It reduces the incidence and severity of muscle and bladder spasms as well as the intensity of neuropathic pain.
CBD has been shown to reduce the incidence of psychosis in Schizophrenics and may modulate symptoms of fear in patients with PTSD.
CBD has been shown to be very effective in the treatment of chronic pain with a much safer safety profile than opioids.
There are a few studies out showing the cytotoxic effects of CBD on breast cancer cells.

All these examples are but a few of the therapeutic possibilities being researched actively.

CBD however still remains a Schedule I substance and thus viewed as illicit when used without a prescription or in a state where the use of marijuana is not legal.

Maybe Bob Marley was right after all:
“Herb is the healing of a nation, alcohol is the destruction.”

Motherhood

My dear, one day soon, you are going to fly away to where my breath can’t warm your face….or…..my hands can’t wipe the tears away…but I’ll always be near you…believe me, I will…how?…well, it’s this thing called….

“Motherhood”

Symbiosis

Death and life all at once. History in the present. Even as the new makes it’s way up, it has to reckon with what was. Most times, the old gives way. It buckles. Not this time. It’s hanging on, giving us glimpses of what the present always makes us leave behind. A strange…

“Symbiosis”

What you do afterwards

“To err is human, to forgive, divine.”
– Alexander Pope, from “An Essay on Criticism”

Probably, the most important lesson I learnt in all of residency can be summed up in these words:
“It’s not the mistake! It’s what you do afterwards that matters”.

These words have accompanied me all these years, I practice by them, taught that to my residents when I was in academics and pass it on any chance I get. It is not only true in medicine but also in the criminal justice system and even at home with our children and spouses. For this discussion though, we’ll stick to medicine.
To elucidate, we have to take a trip back to 1999.

“To Err is Human: Building a Safer Health System” was a report issued in 1999 by the U.S. Institute of Medicine that detailed medical errors in the US healthcare system and the human as well as financial toll it was exacting. The figures were sobering. Between 44,000 to 98,000 people die each year as a result of preventable medical errors. They have been estimated to result in total costs of between $17 billion and $29 billion per year in hospitals nationwide!
It was pointed out in the report that, system failures and less individual provider mistakes were responsible for most medical errors. The push since has been to reduce medical errors and improve patient safety and the results have been encouraging.

However, the fact remains that physicians are only human and like the saying goes, “To err is human…” and that is where my lesson comes into play.
Sooner or later, every physician is going to make a mistake. Show me a physician who hasn’t made a mistake before and I’ll show you a doctor who hasn’t practiced long enough or doesn’t practice at all.
So if we are prone to make mistakes, shouldn’t there be a readiness to face and deal with these errors when they happen? Beyond the checklists and time-outs, beyond the constant threat of loss of accreditation and fines, shouldn’t we as physician on an individual level be ready to deal with that mistake?
That mentality of “It’s not the mistake! It’s what you do afterwards that matters” takes away the fear that dogs one when a mistake is made. It makes one communicate clearly with the patient if possible and explain what happened and what will be done. It allows one to keep a level head and work alone or with a team to reverse or limit any damage. It also reduces the incidence of lawsuits.
This mentality demands something from the physician. It demands a certain honesty and strength of character. One should be able to say, “I screwed up. Now how do I fix it?” It demands empathy with the patient à la “If it was me…”
I know, it is much easier to sweep things under the rug of unintelligible medical speak or blame someone else but that only stokes the fire of trouble down the road and possible harm to the patient.

To help develop this mentality, a mantra that was drummed into me during residency helps. It was, “What is the worst thing that can happen now and what would you do about it?”
With that kind of mind set, one tends to be prepared for whatever but most importantly, one tries to prevent whatever form happening. One tends to see all those checklists on a personal level and that readiness on a personal level ultimately translates to one on the team level too.

Most physicians do as Hippocrates said and try do do no harm. However since the human is plagued by fallibility, maybe accepting that and factoring it into our daily practice may help. So even as you go about your day, remember, “It’s not the mistake; it’s what you do afterwards that matters.”

Petals

Just me and you against the world…nothing bothers us….we let all the noises just buzz by and concentrate on us….together as one….together as…

“Petals”