Jebet Cheserem: Life in brain surgery

Jebet Cheserem comes for the breakfast interview carrying a human skull in her handbag. OK, it's not a real skull, it's an anatomical human skull model, the type that doctors place on their desks to gravely point at with their pens, as they break down medical jargon to laymen.

Dr Cheserem is an assistant professor at Aga Khan University Hospital and a consultant neurosurgeon. She has a subspecialty interest in skull base surgery and pituitary.

She treats trauma, tumours, birth defects, the brain, spine, types of strokes, and epilepsy. She's UK trained (University of Southampton), a Fellow of the Royal College of Surgeons, and a Weill Cornell Global Health Fellow who — until recently—was based in Muhimbili Orthopaedic Institute in Tanzania. As a Skullbase Fellow [yes, there is a thing like that, it turns out], it seems befitting that she would bring a skull to the meeting with Jackson Biko.

A skull in a handbag, doc?

Yes, but I try not to carry it to parties.

How was your childhood?

It was a happy childhood. I was born in Nairobi, and then spent a bit of time in Nakuru, a brief period in Kisumu, and then we came back to Nairobi. I went to Our Lady of Mercy Primary in South B, then Precious Blood Riruta. On the promise of scholarship, I ended up doing A levels with the intention of travelling.

I have always been a curious mind, I had parents who were very curious about life. And so I thought it would be nice to go abroad. Mom is a gynaecologist, she teaches at the University of Nairobi. My late father was a civil engineer, in irrigation systems. He worked for the National Irrigation Board. When I asked him why he chose what he did, he said ‘the women in my life spent all day fetching water so he spent his life trying to get water to people.’

Was this planned, being a neurosurgeon, or did it take its shape?

It’s happenstance. Having two parents who were in the science field, I was a bit of a geeky child. I didn’t even know what fingers were called, I used to call them phalanges because I used to read my mother’s books. (Laughs). I also read a lot of geology and physics. I settled on medicine because I was fascinated by human biology.

What’s the most fascinating thing about the human head and brain?

One of the most fascinating things is when one is young. So imagine a baby born completely helpless. Within 18 months, they learn language, movement, coordination, they show feelings, and they start to develop associations. So the human brain is incredible.

There’s something called neuroplasticity and that’s the brain’s ability to adapt. Compared to other tissues, you don’t make a new brain when you reach a certain age but your cells start to adapt and allow you to perform in a way that you didn't do before.

How do you feed your brain?

I stay curious. I like to read, I spend more time than I should on the Internet. And I like to meet people. I think that ultimately people are like books. No two people are the same. I’m a bit of a people watcher.

What’s been the biggest revelation that impacted your life by opening up people's heads during surgery?

The fragility of human life. This is someone who got up in the morning, went to work, an event happened and it doesn’t matter how, or where you are in life but when you’re on the theatre table we’re all the same.

Does operating on people, opening them up and patching them up, shift your sense of spirituality, of religion, even?

(Laughs) I was afraid you’d ask that. I was brought up in the AIC church. Very devout. So far you think I’m civilised, I don’t want to show you another side of me. (Laughter) But the environment that you grow up in shapes you. You tend to take what you see around you as a given, as the standard by which life should be dealt with. Then you travel and your world gets turned upside down.

When you deal with your human body ultimately you’re dealing with mortality and as I said it’s about fragility. When I left to go to university, I was a devout Christian. I knew all the answers, I was very clear about life. Now I think I live in the greys. I am a spiritual person. But I’m less dramatic about religion. I think that people express it very differently, I’ve seen myself change over time. Interestingly, a lot of doctors who are studying neurosurgery are either super devout Christians, or atheists or agnostics.

As you acquire more medical knowledge and experience, do find yourself getting closer to God?

On the contrary. Religion is about human practice. Religion is very ritualistic and all cultures have their rituals. Indeed medicine has its ritual. I did some cardiothoracic when I was a junior where you stop someone’s heart and then later on you restart it. And then you’re asked, was the person alive or dead while you were doing this surgery? Because you can stop and start their hearts. Are you god? (Laughs) Who is the giver of life here? (Chuckles) I think if you deal with things to do with mortality you end up standing outside society.

Initially, you become very confused. You find that a lot of people go through a stage where they stop going to church or the temple because they’re trying to figure out, they are asking questions and looking at how to connect with God. But then you start to find your spirituality. But do I believe in a higher being other than myself? I do. So, in short, I think it makes you very spiritual but less religious.

Have you ever seen the hand of God in your work?

(Chuckles) Is the hand of God the work of a higher being or the hand of God the unknown in science? I don’t know how to answer that but here is a story. I’m an intern in the UK. The guy is very sick, we run numerous tests, nothing. He gets into ICU and we do everything but he doesn’t improve. He’s going to die. We call his family and tell them we can’t do anything but wait. He even gets his final rites. He continues living without medication, just water.

Over the next month, we call the family two more times, sure that he will not make it but he does each time. Not only did the guy survive, but the guy also walked out of the hospital without aid. What was that? Was that a miracle or was that the edge of science? I don't know.

It’s like the twilight zone.

Self-resolving. I mean medicine is about keeping someone going until the body heals itself. So somewhere around, his own body started to heal itself. But what is that? Is that a miracle of God? Or as I said, is that the end of science as we know it? I don't know.

Do you find that you understand death more now?

I understand death less now. Physics said energy is never lost, it just changes from one form to the other. So does that make the idea of reincarnation a perfect concept because you never really go away, you just come back in a different form? Or do we go to heaven? And even that it’s not even to do with religion.

I think by the time I was a child I realised there are different versions of heaven depending on your culture. So as a Kalenjin, mine has a lot of cows and for somebody else, maybe for you it has a lot of fish, I don't know. (Chuckles) I think what it does is that you realise that you don't have to know everything.

Do you always wonder if you can be more than one thing in life? Like perhaps you can be a good carpenter on top of being a good neurosurgeon?

I think one of the ideas of modern time is the idea that your identity is singular. But it’s not. I think as African women we always knew that we were going to change our identity. When you’re a young girl, you’re told one day you’re going to be a wife, a mother, then you’re going to join which community. So what you learn is your identity is not fixed. And then more than ever, today’s world calls for people to be less dogmatic about the identities that they hold, whether it’s on their careers or their cultures and stuff like that. I think we should allow people to enjoy little pockets of themselves.

What do you find to be very dominant in this season of your life?

Change. It’s a time when everything is just changing. I mean I’ve changed countries, I’ve changed jobs, making a new social circle, I’m finding a new language. I’m realising, for example, the western education that I received is not directly translatable to Africa. Things like the concept of time. We don’t have 60 minutes in African time. (Laughs) Even the very idea of what success is has changed for me.

I'm not ticklish under my feet. Is there something wrong with my nervous system?

(Laughs) No, you were just made that way.

Are you ticklish under your feet?

(Chuckles) That’s top secret. Areas of vulnerability.

What question are you trying to answer now in your life?

(Long pause) I think professionally I’m trying to figure out what my next 10 to 15 years will look like. I’m not going to have the same career I would have had if I was in Europe. But I think the most fascinating thing about coming back to Africa is that the average age in our continent is 19. Which means Africa is a teenager. Teenagers are all about possibilities. It means that I have no idea five years from now how my career is going to be.

Are you married?

No.

Children?

No.

Cat?

No.

Dog?

Yes. Just a new one.

Tell me about the dog.

The dog? She’s sassy. She’s six months which means she’s a teenager too in dog terms. And I like coming home to her because I suppose it’s not like having children but it’s about the distractions of life. Whatever I did at work doesn’t matter. I’m going to do something that will make her wag her tail and jump at me. Life is much simpler with a dog. For me, it’s quite nice having a dog. I spent all the time I was abroad, my life was too unstructured to allow me to have a pet, and I've always wanted a pet.

When was the last time you were very unkind to yourself?

(Long pause) I think in my 20s and early 30s. When you’re trying to do it all. You want to keep this spick and span home, you want to be the best at work, and you want to do whatever... and effectively my body shut down. I had to stop and re-evaluate what I was doing. I realised that it didn’t matter so much, that I didn’t have to be so perfect about everything.