Danielle Ofri, MD, PhD
Bellevue Hospital, New York City, United States
From Medicine in Translation: Journeys with My Patients, Copyright © 2010 Danielle Ofri, Reprinted by permission of Beacon Press, Boston
There was a sharp rap at the apartment door. When Samuel Chuks Nwanko opened it, he saw a young man standing in the hallway wearing a stained denim jacket over a University of Nigeria T-shirt. The whites of his eyes were spidered with crimson streaks. He was probably a fellow university student, but not in the civil engineering department. Samuel didn’t recognize him.
“Are you Chuks?” the student asked, his voice quavering as his Adam’s apple bobbed unsteadily.
Probably drunk or high, Samuel thought. His fiancée Alaba and her friend were watching a movie in the bedroom and he didn’t want some stoned student making trouble. Besides, they were about to leave for church and he didn’t want to be late. But rudeness would only exacerbate things. “Chuks just left,” Samuel said, figuring it wouldn’t take much to outsmart a drunk.
The student laughed a thin, drawn-out laugh, reaching toward the doorframe for support and stumbling closer to Samuel. His breath was rancid.
Definitely drunk, Samuel thought. Probably brewed his own ogogoro. Samuel started inventing another polite excuse to send the student off, when, out of the corner of his eye, he noticed movement at the end of the hall. Six other students turned the corner, their bodies edging out the light from the weak hallway bulb. As they strode towards his apartment Samuel realized he was about to be mugged. That was when the first student pulled a homemade gun out of his jacket.
Samuel slammed the front door of the apartment, yanking the lock closed. He pulled himself into the bedroom where the movie was playing and locked that door too. Alaba and her friend jumped up from the bed at the sudden noise. Samuel grabbed his cell phone, punched in the number of the police, and started some quick mental calculations: It would probably take five to ten minutes for those guys to break down two wooden doors with locks. The police—if he managed to get through to an officer who wasn’t taking a cigarette break, or who didn’t demand an upfront bribe—could take thirty minutes to arrive. In five-to-ten minutes Alaba and her friend could probably hide themselves under the bed. Samuel would probably have time to throw his laptop under the bed with them, but the TV was a goner for sure. His cash was hidden behind the bureau, but there were seven of them and they’d probably trash the place. The bedroom window was narrow—not practical for escape. In any case, Nigerian building codes didn’t provide for fire escapes, so there wouldn’t be much option from the fourth floor, save a leap to the ground.
But Samuel wasn’t even able to complete the first thought. Within thirty seconds both doors were breached and seven sweating men burst into the bedroom, the gun held aloft like a banner. There was a strange moment of calm, of heaving silence. Every muscle of every person in the room seemed frozen. There was no movement, save the nervous darting of twenty eyes sizing up the situation. Samuel’s cell phone was still pressed against his ear—his call hadn’t even gone through yet.
Then, one of the students drew a knife. The blade shimmered as it moved swiftly to knock the phone down.
What an odd thing to see your own ear topple onto the ground yet not feel a thing.
Samuel stood staring down at his ear, unable to react. He was vaguely aware of Alaba and her friend being hustled out the door, but the air around him had solidified like slate, his body ossified into stone. When the first blow arrived, it was a shattering explosion, pain chiseling in all directions. The gang then pounced—pummeling him with fists, kicking him in the gut, slamming him in the face. Suddenly his body was dissolving, disconnecting from him, his flesh jellying into nothingness.
The students argued over who got to kick where. There didn’t seem to be a leader, and they bickered with each other as much as they beat up Samuel. Then there was a silver object that Samuel couldn’t identify. It whistled as it raced through the air, again and again. It made a distinctive metallic slap each time it contacted his skin. But by then he could feel nothing.
After ten minutes, or maybe fifteen, or maybe thirty, they ceased. Like a communal exhalation, their breath was spent. Samuel lay motionless in the stunned silence, aware that he possessed no sense of his body. He was surprised that thoughts continued to be generated in his head—by all counts he knew he should have been unconscious. Perhaps that would be coming soon. He hoped they would begin ransacking his room—that would at least offer respite. The students stood silently, panting, regrouping. Then one pulled out a five-liter canister.
Water, Samuel thought. He knew of this routine—after the beating, thieves would give the victim water to help them recover just a bit, just enough to reveal where the money and valuables were hidden. Perhaps after he drank some water he’d be able to concentrate on memorizing their faces—right now they were a blur. Alaba had probably called the police. It wouldn’t matter though—these thieves know how to be quick. They could dismantle an entire apartment in minutes. By this point, Samuel didn’t care. They could take his TV, his laptop, his telephone. He just hoped they wouldn’t steal his bible. It was a gift from his father before he’d left for university. It sat on the bureau, dangerously obvious with its cover of fine mahogany leather.
At the sight of water, a thirst as he’d never experienced arose in his body. It was like flames engulfing dry tinder. It lapped over his wounds—a sensation of dryness, of evisceration. Even if the water was just to make him talk, he desired it desperately. He would have grabbed the water from their hands if he’d been able.
They held Samuel’s mouth open and poured the water in. Samuel waited for the fire to slake. He waited for the thirst to quench. But nothing registered. He could neither feel nor taste the water. He couldn’t even sense that liquid was entering his mouth. But he could see them pouring. He could see the clear liquid streaming from the canister.
Perhaps the fire in him was causing the water to evaporate before it reached his lips. Perhaps his throat had closed up and was refusing water. Perhaps God was testing him, denying him water until his soul was pure enough. Perhaps he was hallucinating and there was no water there at all.
Then Samuel noticed something peculiar. After all the sloppiness of their punches and kicks, the thugs were unusually assiduous in handling the water. If a few drops spilled onto their hands, they spat curses, snapping at each other as they scrambled to wipe it off. That was when it dawned on Samuel that the liquid probably wasn’t water. He didn’t know what it was because he could feel nothing, but instinct told him to close his mouth and refuse to drink. The attackers grew livid, wrenching his mouth open, dumping the rest of it down his throat. Rivulets sloshed over his face and head.
Then they grabbed a 4×4 plank. With one resonant slam on the head, Samuel was out cold. The attackers dashed out of the room, leaving the canister of sulfuric acid on the concrete floor.
As was the practice after a student was murdered, classmates printed a T-shirt and distributed it as a memorial. Samuel Chuks Nwanko—it read under his color photo—4/1/80-2/17/05. One more death attributed to a violent rapacious society.
The patient’s name appeared African. From his date of birth I could tell that he was 27 years old. That’s all I knew, and when I went out to the waiting room, I scanned for a young, black-African male. I was at first puzzled by the person who answered. I couldn’t tell if he was black or white—not that it should have mattered—but names were often mixed up in the waiting room and I needed to be sure he was the correct patient. His face was a patchwork of pink, white, and black, and he wore oversized, wrap-around silver reflective sunglasses. The brim of his Fedora hat rested on the top edge of the sunglasses. His jacket was pulled close around him and the collar raised high.
Sitting down in my exam room, he removed neither his hat, nor his coat, nor his glasses. Now that we were sitting only three feet apart, I could see that his face was puckered with stiff ridges and deep gouges like a hastily pulled wax sculpture. In the center there was no nose, only two nostrils opening up from the rubbery scars of his face. The fibrous lips moved stiffly and some of his words were difficult to discern.
“What can I help you with today?” I asked, steeling myself for whatever I might be about to hear.
He pulled a folder from his bag. “I am trying to find out about career training,” he said, opening the folder and extracting a sheaf of papers. “I was a civil engineering student and I wish to re-enter university to complete my studies.”
He pressed the papers toward me. They were transcripts from the University of Nigeria, carefully collated and neatly clipped.
“I think there might be a slight misunderstanding,” I said. “I’m a medical doctor, and this is a general medical clinic. For things like career training and college issues, I think you’d need to talk to the social worker.”
There was no way to read Samuel Nwanko’s expression, but his taut voice seemed to grow tighter. “I was told that you would be able to help me. I have waited for many months for this visit.”
“I’m so sorry,” I said, “but I can only help with the medical issues.”
The silver reflective sunglasses seemed menacing, but of course they were merely neutral plates of plastic. Without eye contact, and with no facial expression visible on his scarred face, there were no nonverbal cues to help our connection.
Growing up as a pastor’s son was not easy. Every aspect of Samuel Nwanko’s daily existence was determined by his father’s involvement in the Pentacostal church. His musical talents were corralled into the church choir. His friends were limited. When the time came for college, Rev. Nwanko chose civil engineering for his son, and enrolled Samuel in a school six hours south, in Rivers State. The concept of questioning parents simply did not exist.
Samuel did not relish engineering, but he was able to pursue his love of gospel music for the first time, listening to any album he chose, recording at local music studios, even cutting his first album. He earned enough money to cover his rent and tuition by writing election jingles and soundtracks for home videos.
But the university—like all the others in southern Nigeria—was dominated by the cults. The cults had started as fraternities, challenging the authorities for more freedoms. But over the years pranks turned serious. Car-jackings and armed robberies abounded, and the minimal response by the police confirmed citizens’ suspicions that the police were in cahoots.
The cults intimidated students into joining with bullying, beatings, and arson. They harassed professors to provide good grades, storming into classrooms to strip professors of their clothing. After several professors were summarily murdered in their classrooms, faculty members began swearing their own allegiance to cults.
The Rev. Nwanko was vocal in his disdain for cults and avid in his desire to claim more lives for Christ. In January, just before the arrival of the rains that marked the end of the brief dry season, Rev. Nwanko scored a coup—he helped the cousin of the governor of a neighboring state leave his cult and come to Jesus. This cousin not only renounced his cult, but he revealed names of high-ranking members. A scandal quickly ignited, spreading through the news media, jeopardizing the governor’s ability to run in the upcoming election.
Within a month, Rev. Nwanko’s car was burned. Cult members barged into his office with bats. Then, the reverend received a threat that “none of his children would have the chance to complete school.” Samuel, the middle son, was six hours away in Rivers State. Phone service in Nigeria had never been especially reliable, and Rev. Nwanko couldn’t get through. Or at least that’s what he told Samuel much later.
Samuel awoke in a hospital. Details of the assault drifted randomly back into his consciousness like unmoored tufts of cotton. For nine months he recovered in secrecy—the reason for his attack withheld from him, the fact of his survival withheld from the public. If it were known that Samuel had survived, his family reasoned, there could be violent retribution. And if Samuel knew that this had been an attack by the cults, not a random robbery….well, his family couldn’t be sure of the repercussions, so they felt it best that his assumption not be corrected.
The Nigerian doctors repaired Samuel’s esophagus that had been burned away by the sulfuric acid, but they did not possess the sophisticated plastic surgery techniques for the extensive facial and retinal burns. For nine months Samuel lay in the hospital bed, swathed in gauze dressings, unmoored from the rest of society, trying four times to kill himself. The cruelest torture was eternal daylight. Without eyelids, the light bore down on him even when he tried to sleep.
After contacting dozens of charitable agencies, Samuel was finally selected by one to receive medical care in the United States. That was when Rev. Nwanko finally told his son the whole story: about the cousin of the governor, about being chased from his office by cult members, about the threats to his children, about trying—unsuccessfully, it seemed—to telephone Samuel to warn him.
When the facts finally settled into him, Samuel expected to be overcome with fury toward his father, blaming him as the cause of the attack, castigating him for not trying harder to warn him about the threat. Was his life expendable, a mere trifling in the greater drive of his father’s righteous zeal?
But the anger did not arise, at least not toward his father. Samuel was angry, yes, that he’d lost the chance to graduate university, to get married. But in his heart he was convinced that this had been his destiny, that God knew from the moment he was born that this attack would happen. His father was not to blame.
Within a month Samuel was in the frigid environs of Buffalo, NY. Skin patches were taken from his thighs and grafted onto his face and neck—a painful and arduous process. But after the stipulated four months of treatment, he had to return to his home country, despite needing many more surgeries.
For the next year he remained holed up in his house, fearing retaliation and violence. Only his family knew that he was there or even that he was alive. When guests were visiting, Samuel was confined to his bedroom, not able even to speak or laugh because the walls were so thin.
It was like he was back on that floor again, the flesh of his body pummeled into oblivion—only now it was his soul that was pummeled. When he could marshal some grains of his spirit, he trawled the web for plastic surgeons, hoping someone might offer the medical care he needed. Most days he simply drew the blankets over his head. Darkness was preferable.
Alaba visited, but their contact was awkward. He knew that he didn’t remotely resemble the man he’d been. They ended their relationship by mutual agreement, but he knew she just needed a graceful way out.
After a year of this subterranean existence, a surgeon on Long Island responded. If Samuel could cover his living expenses, he would perform the surgeries without charge. There was only one way that Samuel could think of to raise money without revealing to anyone in Nigeria that he was alive—cutting an album.
Covering his face with a loose linen handkerchief, wearing a felt hat with a large, protruding brim, Samuel revealed his private agony for the first time, in the only manner he could—singing to an anonymous microphone in a soundproof studio. He poured out all that he was able, crying in a way that only his music could offer, cloaking it all under a stage name. The $3000 in CD sales was just enough to land him in the suburban bliss of Patchogue, Long Island.
When Samuel Nwanko finished the story, my mouth felt parched. It was a burning dryness that snaked up into my head and burrowed into my stomach.
“What…,” I finally stammered, “what are your main concerns right now?”
“Career training,” Mr. Nwanko said, without missing a beat. “I must matriculate into university so I can finish my degree.”
The ordinariness of his concerns took me aback. I guess I expected his main concerns to be about his injuries and their repair; how could he focus on anything else? On the other hand, maybe it made perfect sense to focus on something else.
I trained my gaze on him as I performed a physical exam, trying to remain dispassionate, the neutral clinical observer, as I noted the nature and extent of the chemical burns on his face, neck, chest, back, and arms.
For the rest of the day, I was edgy. My temper was short, and I could not settle into a smooth groove of work. Whenever I reached for a glass of water, I winced. Even at night, I was restless, unable to find a comfortable position despite my fatigue. When I finally fell into an uneasy sleep, I dreamed of reaching a clear mountain stream after a strenuous hike. The water was clear, menacing. I was too afraid to drink.
“Con intimo sentimento” was how the largo movement was marked. Intimate sentiment—what exactly was that?
I slid out the end-pin of the cello and tightened the hairs on the bow, applying a few quick strokes of rosin. I’d been plugging painfully through the fifth Vivaldi cello sonata, measure by measure, for almost a year now. We were up to the largo movement—largo doloroso, to be exact—and the editor had marked it “con intimo sentimento.”
I tried hard to think beyond the mechanics of playing, to the intimate sentiment of the music, but all I could see was the disfigured face of Samuel Nwanko. The music was indeed slow and sad—largo, doloroso. The rich, melodic tones in B-minor stretched painfully across measures, allowing ample time for reverberation and contemplation. When played by more competent hands than mine, the cello seemed to weep during this movement. When I thought of Mr. Nwanko, that was what I wanted to do. I didn’t seem to be able to fall in with his pragmatic optimism for the future—I just wanted to grieve over what was stolen from him. I couldn’t ever know the intimo sentimento of Antonio Vivaldi in the 1730s—the same years in which Bellevue Hospital first opened its doors—but his Baroque lament from Venice exactly captured my sadness about this young Nigerian man almost three centuries later.
DANIELLE OFRI, MD, PhD, DLitt (Hon), FACP, is an attending physician at Bellevue Hospital and Associate Professor of Medicine at New York University School of Medicine. She is author of three books about life in medicine: Singular Intimacies, Incidental Findings, and Medicine in Translation. She is co-founder and editor-in-chief of the Bellevue Literary Review. Her website is: www.danielleofri.com. Her blog is: Medicine in Translation.