About colon cancer

In kenya, cancer ranks 3rd as a cause of death after infectious diseases and cardiovascular disease. It causes 7% of the total national mortality each year.

This gives our health care system a mouthful as we have to deal with both communicable and non communicable diseases (double burden of disease). With cancer being the leading cause of death worldwide,accounting for approximately 7.6 million deaths annually, it is only necessary to start dealing with the cancer menace sooner other than later. This is in light of the fact that the cancer mortality rate is predicted to continue to rise with an estimate of 13.1 million people worldwide affected in 2030.

Colon cancer is one of the most common cancers in the world. In kenya, it constitutes 40-50 % of all cancers of the large intestine with the mean age of diagnosis being about 50 years. It is highly curable, particularly if caught early and when localized within the intestine. With time, like most cancers it spreads and hence makes cure more difficult.

Risk factors would include a personal history of colon or any other cancer, Tobacco use, irritable bowel disease, family history of ovarian, endometrial or breast cancer among others.

Early diagnosis and treatment is possible. This is achieved by screening the at risk patients. The screening test is inexpensive and infrequent, to be done after every 3 years. This is the fecal occult blood test (FOBT ) . It is the proper screening test for the at risk population. It is basic stool test that checks for blood that is invisible to the naked eye but can be seen on microscopy. If the stool test is positive then further tests will be recommended and advisable.

The early features of colon cancer are quite nonspecific. They include discomfort, weight loss, changes in bowel habits and tiredness. This can indicate any other gastrointestinal disorder and are not indicative for colon cancer. However the need to seek medical advise cannot be overlooked and a high index of suspicion is required on the side of health professionals for an early diagnosis to be achieved.

Reference; NATIONAL GUIDELINES FOR CANCER MANAGEMENT KENYA.

By Julian Wanjira Wachira

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TUMORS OF THE LARGE INTESTINE

Benign

Polyp – a clinical description of any elevated tumor.

Polyps can occur:

  • Singly
  • Synchronously in small numbers or
  • As part of a polyposis syndrome

In familial adenomatous polyposis (FAP), >100 adenomas are present.

Adenomatous polyps

Classification of polyps of the large intestine

Adenomatous polyps vary from tubular adenoma rather like raspberry on a stalk, to the villous adenoma, a flat spreading lesion.

Solitary adenomas are usually found during the investigation of colonic bleeding or sometimes fortuitously.
Villous tumors more usually give symptoms of

  • Diarrhoea
  • Mucus discharge
  • Occasionally hypokalaemia

Risk of malignancy developing in an adenoma increases with increasing size of tumor.

Adenomas larger than 5mm in diameter are usually treated because of their malignant potential. Colonoscopy snare polypectomy click here or diathermy obliteration with hot biopsy forceps click here can be used.

Huge villous adenomas of the rectum can be difficult to remove even with techniques per anus, and occasionally protectomy click here is required ; the anal sphincter can be preserved.

Proctectomy is a surgery to remove all or part of the rectum.

Familial adenomatous polyposis

Clinically defined as presence of >100 colorectal adenomas.

Over 80% of cases come from patients with a positive family history.

20% arise as a result of new mutations in the adenomatous polyposis coli gene (APC).

It is less common that hereditary non-polyposis colorectal cancer (HNPCC) and accounts for <1% of colorectal cancer (CRC).

Although the large bowel is mainly affected, polyps can occur in the stomach, duodenum and small intestine.

It’s inherited and mendelian dominant conditions.

Risk of CRC is 100% in patients with FAP.

Males and females are equally affected.

It can also occur sporadically without any previous sign or history, presumably by new mutations. There’s often, in these cases, a history of large bowel cancer occurring in young adulthood or middle age, suggesting preexisting adenomatosis.

FAP can be associated with benign mesodermal tumors such as desmoid tumors and osteomas. Epidermoid cysts can also occur (Gardner’s syndrome) ; desmoid tumors in the abdomen invade locally to involved the intestinal mesentery and, although non-metastasising, they can become unresectable.

Up to 50 per cent of patients with FAP have congenital hypertrophy of the retinal pigment epithelium (CHRPE), which can be used to screen affected families if genetic testing is unavailable.

Clinical features

Polyps are usually visible on sigmoidoscopy by the age of 15 years and will almost always be visible by the age of 30 years.

Carcinoma of the large bowel occurs 10–20 years after the onset of the polyposis.

One or more cancers will already be present in two-thirds of those patients presenting with symptoms at the time of diagnosis

Symptomatic patients

Are either patients in whom a new mutation has occurred or those from an affected family who have not been screened.

They may have

  • Loose stools
  • Lower abdominal pain
  • Weight loss
  • Diarrhoea
  • Passage of blood and mucus

Colonoscopy is performed with biopsies to establish the number and histological type of polyps.

If over 100 adenomas are present, the diagnosis can be made confidently.

If there are no adenomas by the age of 30 years, FAP is unlikely. If the diagnosis is made during adolescence, operation is usually deferred to the age of 17 or 18 years unless symptoms develop.

Screening policy

  • At-risk family members are offered genetic testing in their early teens.
  • At-risk members of the family should be examined at the age of 10–12 years, repeated every year.
  • Most of those who are going to get polyps will have them at 20 years, and these require operation.
  • If there are no polyps at 20 years, continue with yearly examination until age 50 years; if there are still no polyps, there is probably no inherited gene.

Carcinomatous change may exceptionally occur before the age of 20 years. Examination of blood relatives, including cousins, nephews and nieces, is essential, and a family tree should be constructed and a register of affected families maintained.

Treatment

The aim of surgery is to prevent the development of colorectal cancer. The surgical options are:

  • colectomy with ileorectal anastomosis (IRA);
  • restorative proctocolectomy (RPC) with an ileal pouch-anal anastomosis, the anastomosis may be defunctioned with a loop ileostomy;
  • total proctectomy and end ileostomy (normally reserved for patients with a low rectal cancer).

The patient is almost always young and likely to prefer to avoid a permanent stoma and so the choice is normally between the rst two options.

The advantage of an IRA is that

  • it avoids the temporary stoma frequently required for an RPC
  • avoids the potential compromise to sexual function that accompanies proctectomy.
  • has a lower morbidity and mortality.

However, the rectum is left and requires regular surveillance, as there is a risk of adenomas and carcinomas in the residual large bowel. Even with optimal surveillance of the rectal remnant, up to 10 per cent will develop invasive malignancy within a 30-year follow-up period.

Restorative proctocolectomy has the advantage of removing the whole colon and rectum (although a small cuff of rectal mucosa may be left behind with a stapled anastomosis). However, there is a pouch failure rate of about 10 per cent. In addition, and particularly where a stapled anastomosis has been created, there remains a very small but denite incidence of cancer developing in the small strip of rectal mucosa between the pouch and the dentate line. This is why some colorectal surgeons advocate complete mucosectomy of the residual rectal cuff and a transanal pouch anal anastomosis, although it is acknowledged that this results in worse function.

Postoperative surveillance

  • rectal/pouch surveillance, with biopsy of the pouch-anal anastomosis.
  • Gastroscopies are also carried out to detect upper gastrointestinal tumours.

Even with prevention of colorectal cancer, FAP patients have reduced life span due to the development of duodenal and ampullary cancers and the complications of desmoid tumours.

Hereditary non-polyposis colorectal cancer (Lynch syndrome)

characterised by increased risk of colorectal cancer and also cancers of the endometrium, ovary, stomach and small intestines.

It is an autosomal dominant condition that is caused by a mutation in one of the DNA mismatch repair genes. The most commonly affected genes are MLH1 and MSH2.

The lifetime risk of developing colorectal cancer in Lynch syndrome is 80 per cent, and the mean age of diagnosis is 45 years.

Most cancers develop in the proximal colon.

Females with HNPCC have a 30–50 per cent lifetime risk of developing endometrial cancer.

Diagnosis

Tumours of the large intestine 1163 HNPCC can be diagnosed by genetic testing or the Amsterdam II criteria:

  • three or more family members with an HNPCC-related cancer (colorectal, endometrial, small bowel, ureter, renal pelvis), one of whom is a rst-degree relative of the other two;
  • two successive affected generations;
  • at least one colorectal cancer diagnosed before the age of 50 years;
  • FAP excluded;
  • tumours veried by pathological examination.

Patients with HNPCC are subjected to regular (every one to two years) colonoscopic surveillance.

Why are we here?

The first lecture of clinical chemistry, our lecturer, Professor Ojwang’ gave us titbits of advice which I’ve held dear to date. Amongst them he talked of the meaning of life. When you ponder, why am I here? What is the meaning of life? What is my purpose on this earth? Since from dust we came and to dust we shall return.

We are driven by fear. Fear of dying. I watched this documentary series called year million and they talk of an age whereby humanity will achieve immortality. We will begin by being able to delete the unwanted genes from our DNA. Is your mother short-tempered? You can eliminate that. Do you want a child who is super smart? Yes, please. You can preprogram their genetic sequence to generate the perfect human being. Which didn’t settle well with me because are we human without imperfections? Then we’ll reach a point whereby telepathy will be made possible to enable engineers and great minds to come up with formidable inventions but what are we without our privacy? Then we’ll be able to upload our minds onto a computer and be able to have a virtual world. This is to avoid death from physical injury such as road traffic accidents. Did I mention we’ll no longer work? Yes, robots will be doing everything for us meaning there will be a generation who’s wonder will be really? You used to work? What is that like? But of course there comes the fear of the robots turning against the human race. I hope you’ve watched Terminator.

Immortality brings about the question, how different would you live your life if death became a thing of the past? The fear of death, I want to believe, is what gives life meaning. We go to school, care about people, go for what we want because we’re afraid of regretting. Thinking about what could have been since we have an expiry date. It’s just a matter of when.

Not to digress, to paraphrase what professor Ojwang’ said, most of all, the essence of life is making and leaving an impact in society so that when you are gone, with all the academic knowledge you acquired in your lifetime, your contribution to the community will remain even as you lay 6 feet under. Build that school you think your community needs, start a dispensary… you have a role to play in community and the impact you make is what makes life worthwhile as you live and even after you are dead.

The impact you make is what makes life worthwhile. Tell me how felt after you last visited that children’s home. When did you last volunteer for something? Can you describe the satisfaction and sense of fulfillment that comes with it? You feel at peace and in line with your purpose when you go out of your way to help others. Both the less fortunate and the able.

This reminds me of a piece my mother shared with me a while back from the daily nation

The founders, Griffin, last words to Starehe boys were, ‘… This world is full of people who do their duty half-heartedly, grudgingly and poorly. Don’t be like them.

Whatever is your duty, do it as fully and perfectly as you possibly can.

And when you have finished your duty, go on to spare some time and talent in service to less fortunate people, not for any reward at all, but because it is the right thing to do.

Follow my advice in this and I promise you that your lives will be happy and successful.

May God bless you all. ‘

Profound. Serving gives life meaning.

The bodaboda man

You will never know lunch time frustration, when you’re hungry, tired, worried about something, until you board a motorbike with an incessantly talking rider.

Ideally, all motorbike riders and passengers ought to wear a helmet meaning no communication can take place. Even in the absence of helmets, the wind blows against the direction of the motorbike meaning sound will be lost in between and hence discouraging talking. But no! Some people’s determination will make you marvel.

I swear this man couldn’t shut up. He went to the extent of literally turning to try and be heard. My heart rate was over the roof the whole of that ride. I almost asked him, do you have a wife? A grandmother at home? A friend to talk to back at home? No? That’s unfortunate because you can talk! I wondered so because I recall one of our lecturers mentioning that while taking a history from patients, especially the elderly, they will tend to go on and on mostly about irrelevant things. They will start telling your about their chicken back at home and you have to politely guide them back to track. They do this because they’re lonely. Yes, they’re lonely. Society has neglected the old.

About a fortnight ago, my cousin broke down while explaining to me how our step grandmother has been neglected by everyone. I mean, we visit her, she visits us but that’s about it. Very few check up calls are made to her and she has to live alone for the rest of her life. She talked about how you could feel the excitement and thrill in her voice everytime she picked the phone. As if she was eagerly waiting for the phone to buzz. It broke my heart honestly and made me start to appreciate the essence of nursing homes. Perhaps it’s about time we embrace this idea and set in motion a plan to cater for the old and to give them a reason to continue living long after their children have moved out and spouses died and no one is around for them anymore save for the occasional visits from their grandchildren.

This is why I did not get offended with the man’s chatter for they say be kind always for you never know what someone is going through.

ACT ON MENSTRUATION WITHOUT HESITATION

This an article I wrote following a training on Menstrual heath Education that I attended in Kampala, Uganda starting 27th April to 1st May, 2015 that, unfortunately, never got published as anticipated.

The future of girls in East Africa remains bleak as many are dropping out of school due to, among others, menstrual related challenges. The society’s stereotypes inculcated in them pertaining menstruation being a curse, makes the girl child believe that their future is bleak the moment they spot blood on their underwear. In Uganda, 61% of girls admit to missing school due to their menstrual period, the numbers continue to soar with each passing moment of our ignorance and the statistics are bound to rocket if we do not act on menstruation without hesitation.

Irise International, a UK charity, organized a training on Menstrual Health Management at Entebbe in Uganda from 27th April to 1st May, 2015. An eye-opener for the Irise ambassadors who were in attendance and a reiteration of what we all know but take obvious. Providing education on menstrual hygiene is paramount. In order to break the silence and rise above the stigma, girls need to be enlightened on the normal physiological process they are bound to undergo; menstruation, because girls matter.

Light needs to be shed on the facts and the myths used by society to put the girl child down. In addition, men need to understand that menstrual hygiene management affects them directly because everyone is a product of a missed period however much they consider women “unclean creatures.” These beautiful, promising young girls should not be bashed, perturbed or miss opportunities because they are menstruating instead, we should empower the girl child to be bold and unshakable on matters concerning her menstruation cycle. Statements such as, “I cannot trust a creature that bleeds for five days and does not die” from our male counterparts are demeaning, disheartening and exposes men’s ignorance on this global phenomenon; menstruation.

The lack of clean water in some areas, sanitation and medical care has negative consequences, especially for the female members. Menstruating girls and women are forced to use mattresses, old cloths, drying them in moist places this, almost always lead to vaginal infections. This is because menstruation is a taboo issue and menstruating girls are flushed to open up about their menstruation.

In addition, there are different ways of relieving painful cramps and getting pregnant is not an effective method. Alternatively, one can take painkillers, exercise, place a warm water bottle on the stomach and incase of severe dysmenorrhea or menorrhagia, a health care should be contacted.

The constant emphasis on our patriarchal society is counterproductive since it takes two to tango. The facilitators of this training spiked my interest the most since they gave up their daily routine and commitments to come and echo how serious menstrual health education is to us and to our sisters, brothers, parents and friends. You can corroborate with me that most people expect a stipend even after offering to volunteer therefore, these facilitators are an inspiration to me and my fellow ambassadors and they should be to you too because if they can, why wouldn’t you?

Last but not least, this training in Entebbe, Kampala taught me many new skills for instance I was able to learn how voluminous effect one’s body language and choice of words has on a conversation. For instance, when trying to convince a chauvinistic, misogynistic set to win politician that women’s anatomy is not something to be used against them. Therefrom, this menstrual hygiene day, break the silence, become a superhero and help to ensure that no girl is ever held back by her period! Act on menstruation without hesitation by supporting friends, teaching others and keeping girls in school. Be your own super hero.

“Maybe I’m tough because I’m a girl.”

If I were born a boy, my father would’ve raised me to be one hell of a macho man.

Growing up I did everything with my dad. When he was changing light bulbs, I was there handing him the bulbs. When he was fixing the doors lock, I was there handing him the screws. When he treated our chicken, I was there to hold their beaks open. When he went out to let loose our fierce dogs, I was there tying up three as he dealt with the other four. When he was slaughtering a chicken, I was there!

I highly doubt there is anything I cannot do by myself. I have done most of the things ever since I left my dad’s shadow by myself. I have moved out and moved in alone. I have fixed my fitness bicycle from only parts to a fully functional, aesthetic piece that I could ride on. I have fixed my bed from pieces, tightened the screws by myself. Oh and its still sturdy. I have fought my way through a lot of things. Growing up, my dad made it a song that only the tough survive. Tough I was made. You have to stand up for yourself. Standing up for myself I did.

The world is a strange, beautiful and dangerous place. Everyone, who has no idea on what it is to be you, will feel like it’s their place to tell you how to live and be and they will breathe down on your neck hard if you let them but I made a decision way before I turned 13 to never let other people to decide who I am. I want to decide that for myself.

I watched a certain series a while back, The Brave, if I’m not wrong and there was a soldier amongst the 6 who was a woman. She was strong, poised and her demeanour a sight for sore eyes. She knew she had to put in work to get to where she was and she never let her femininity stop her. She did not let superiority complex infiltrated men intimidate her either. This one time they were on a mission to save the ambassadors daughter from a heist and a little girl was passing by the gates. She saw the lady, gun hanging off her straight shoulders and stared in awe.

“You’re tough… but you’re a girl,” the little girl stammered in awe
“Maybe I’m tough because I’m a girl.” She replied with a smile and straight shoulders, her sophisticated gun dangling off them.

Never underestimate a strong woman.

You can watch that here:

https://m.facebook.com/story.php?story_fbid=193478867888203&id=120404095195681&_rdr

It’s one of the most profound things I’ve heard in my life and I couldn’t help but think about it this morning. I hope you never let being a woman stop you and I hope, as a man, you never let women be intimidated out of achieving their full potential by men with delicate egos. These are your sisters, friends, mothers and daughters.

Add this series to your watch list! 🙂

Do you fight in your relationship?

Do you think some people only feel truly alive in the presence of conflict? Both internal and external. Do some people thrive on it? I have these, what you would call a power couple, neighbors who at first glance resemble any ordinary couple you’d see going around and about their business. They’re cohabiting and the lady is a stay-at-home girlfriend or wife. Didn’t the court rule the other day that come-we-stay is proof of marriage?

Not to digress, it’s a war zone in my area of residence. Every morning and evening. As soon as the guy gets home in the evening, not more than 5minutes later and its shouting and yelling and utensils being thrown around and physical abuse. It’s a pity these walls are not soundproof because they sure are not bashed to air their dirty linen in public. What baffles me is, what is it that two people could fight about yesterday, today, tomorrow and the day after tomorrow that is incapable of being resolved that they have to reiterate the argument daily? Its disturbing to hear people verbally fighting and even physically and you’re not in a position to interfere also its toxic to the children around. How does this affect children exposed to violence in their own homes or in their areas of residence growing up? I read an article by Troy Onyango a while and the protagonist had grown up watching the father physically abuse his mother and in his adult life, after marrying, he made a habit of beating the daylight out of his wife every dusk. He would come home, drunk or not, and start hurling insults and throwing blows at the wife. In his mind, he only knew to express love with violence. To him, love did not exist where violence didn’t. Sad, right? Disturbing too.

What baffles me is why would two adults consent to live together disharmoniously? This is how people die! It starts with verbal abuse, then a slap here and here, next it’s punches being thrown and next thing you now, someone slips into unconsciousness never to come to again.

Domestic violence is a real issue amongst us and we need to find ways to address this issue to reduce the mortality rate in both parties involved. This mortality rate is increased by both physical and psychological factors. You should see the guy walking around, he’s usually agitated for no apparent reason and rude. Stress is one of the risk factors for several conditions. High blood pressure being one of them.

Some of the peaceful ways to resolve conflict are:

  1. Calmly talk about it and in case you cannot calmly talk about it at that moment, excuse yourself and resume the conversation when your temper is out of control.
  2. It’s not a competition. Going into an argument with the mentality that you want to win will destroy the relationship. Its about meeting halfway, not winning the argument.
  3. Know your trigger points and avoid them. If you know that your partner is the type to use your words against you especially out of context in an argument, avoid exchanging words with them as this might escalate your temper and end in a disastrous way. Also, try to tell them beforehand that you do not like it so they can curb it or even better stop entirely.
  4. Don’t be afraid to involve a third party when things sprawl out of control.

Lastly, a caveat for those women who ignore the tell-tale signs of a violent lover, better to be safe than sorry. Below are some of the warning signs also, suggestions of how to tackle this issue will be highly appreciated and acted upon.

If you’d like to share you story please text me 0727946060 or email me at ybritty@gmail.com. It can be done anonymously. Don’t be ashamed of your story, it will inspire others.

Don’t we just love the dead?

Don’t we just love the dead? Is a question one of my lecturers posed during one of his lectures which made me pause and think. They say that people won’t worry about your existence, they won’t call you to check up on you, they might not even help you in your time of need but will book the earliest flight they can to attend your funeral. They will buy exquisite bouquets of flowers to place them on your grave and then they will gather and talk about how they wish they called you the last time they attended a conference in your area of residence or how they should’ve called you for that coffee, returned your missed call. Their faces full of regret and shame

There’s this song I used to love as a teenager called If I Die Young by The Band Perry. It’s lyrics and link

https://m.youtube.com/watch?v=7NJqUN9TClM&feature=youtu.be

[Intro]
If I die young, bury me in satin
Lay me down on a bed of roses
Sink me in the river at dawn
Send me away with the words of a love song
Oh-oh, oh-oh

[Verse 1]
Lord make me a rainbow I’ll shine down on my mother
She’ll know I’m safe with you
When she stands under my colors
Oh and life ain’t always what you think it ought to be, no
Ain’t even gray but she buries her baby
The sharp knife of a short life
Well I’ve had just enough time

[Chorus]
If I die young, bury me in satin
Lay me down on a bed of roses
Sink me in the river at dawn
Send me away with the words of a love song

[Pre-Chorus]
The sharp knife of a short life
Well, I’ve had just enough time

[Verse 2]
And I’ll be wearing white when I come into your kingdom
I’m as green as the ring on my little cold finger
I’ve never known the lovin’ of man
But it sure felt nice when he was holdin’ my hand
There’s a boy here in town, says he’ll love me forever
Who would have thought forever could be severed by

[Pre-Chorus]
The sharp knife of a short life
Well, I’ve had just enough time

[Bridge]
So put on your best boys, and I’ll wear my pearls
What I never did is done
A penny for my thoughts—oh no, I’ll sell ’em for a dollar
They’re worth so much more after I’m a goner
And maybe then you’ll hear the words I’ve been singin’
It’s funny when you’re dead how people start listenin’

[Chorus]
If I die young, bury me in satin
Lay me down on a bed of roses
Sink me in the river at dawn
Send me away with the words of a love song

[Outro]
Ooh, ooh, the ballad of a dove
Go with peace and love
Gather up your tears, keep ’em in your pocket
Save ’em for a time when you’re really gonna need ’em
Oh, the sharp knife of a short life
Well, I’ve had just enough time
So put on your best boys, and I’ll wear my pearls

When she sings about how her thoughts will cost more after she’s a goner and she talks about how people listen more when you’re dead she’s basically reiterating the concept of us loving the dead more than when they were alive. Michael Jackson made more money dead than alive. The irony.

So why do we do what we do? Why do we tend to care more about things or people after we lose them? Is it because familiarity breeds contempt? Or is it because we’d rather weep than laugh?

Make that call, help a friend and most of all be there when your loved ones need you. You only have one family.

Can you cheat death?

Have you ever been the bearer of bad news? No, terrible news?

Are you one of those shoot the messenger kind of persons? Well, then imagine how hard it is for the bearer of the news especially when the message is life changing. Tell me, how do you look at a terminally ill patients’ family and deliver the news when they ask you, “Daktari, kwa nini hii ugonjwa haiponi na amekuwa akishinda hospitali?” Tell me, do you go have a glass of water first, wipe and imaginary beard of sweat from your forehead or do you rehearse in from on the mirror first putting on you most grave facial expression just to gain the confidence to deliver the news and an empathetic expression to comfort them? What do you do when the mother breaks into a wail and starts tugging at her shawl and her hands quickly find the back of her head as she calls the names of her ancestors? Do you stand there awkwardly and ask them whether they have any more questions or clarification or do you silently weep with them? One doctor once told me that contrary to popular belief, one never gets used to death. Not even morgue attendants. Not even brushing shoulders with loss hardens you enough to eliminate the despair and exasperation that comes with losing a life, even worse, a loved one. If you’re a doctor you sleep wondering what could have been done differently or what could hare been detected early enough to evade the tragedy.

It changes you.

And what about the patient? Do you tell them that you only live once could never hit closer to home? Or do you stare at their eager, expectant eyes, bite the inside of your tongue and utter I’m sorry then follow it up with the dreaded but?

Isn’t it dreadful? To be the one to let a human being know that there’s no further hope for them save for enjoying the taste of air while their lungs can still allow them?

Which reminds of one of my favorite books that has a similar storyline and moved me tears and desperation where the author, Paul Kalanithi says that “Even if I’m dying, until I actually die, I’m still living. “

Of the old, current and yet to come

There are people once upon a time, their names used to be the reason I smile, now I don’t really know, it is just a mix of strange emotions that I don’t recognize and maybe that’s the thing about people; they’re meant to be temporary. Most things really, life itself is the ultimate example of impermanence. We are born, we grow, we wither, we perish.

If you believe in reincarnation like the Buddhists do then yes, you have several lifetimes and perhaps that’s why we experience déjà vu. Also, every ill thing you do in this lifetime will haunt you in this lifetime or the next. I learned this from a certain Buddhist my colleagues and I met in Entebbe, Uganda about two years ago. He is one of the Rwandan genocide survivors and after undergoing what I imagine are the 5 stages of grief( denial, depression, anger, bargaining, death) , exempt the fifth, he found his answers in Buddhism so he quit being a Christian and permanently relocated to Rwanda. His face told stories I’d never seen on anyone’s face before. He looked as peaceful as the sea on a calm night, clean shaven head you’d think he had decided to shave away every strand of hair that told tales he no longer wanted to tell, his gaze intense and his eyes would drift away as he told us of how his parents and brothers had been murdered right in front of his eyes and how he couldn’t sleep the months that followed. How he spent nights in church questioning God’s intent with his misfortune. How he had taken up karate when he felt neglected by God and decided that he would never fail at self defense again, for himself and for those he held dear. He spoke as if he was relieving the experience. His voice low, audible and with no betrayal of the anger he must have once felt. He walked and sat with a poise that emanated strength and strong will. His slow, almost calculated steps could tell you that life had taught him the value of patience the hard way. I had only watched the Rwanda genocide movies and even then, I couldn’t sleep easy that night. The events were horrendous and gory. I could not have possibly been able to walk a step in his shoe, leave alone a mile.

Not to digress, we clearly are mortal and therefore we shall die. Valar morghulis (if you know, you know).

So, do not hesitate to do that which scares you. An author signed one of her book copies for me and here’s what she wrote what you want is on the other side of fear. I still smile when I read it because it’s simple yet profound. So go ahead and write that book you’ve been wanting to get to, write that research proposal you’ve been putting off so much, call your mom and tell her you love her, appreciate your father, text that person you love but in your head (lol) – say it out loud already! For most hearts are broken by words left unspoken.

And by the way, this is inside the temple we visited.

Outside the Temple.. Kind of blurry though.

The view of the Lake at Entebbe(its to die for, right?) The water is crystal clear here.

So it is true there are people you meet and they change your life in ways you can’t explain and there are people you meet that you want to forget.

Be phenomenal or you will be forgotten.