They thought he was a pharmaceutical drug representative hoping to sell some medicine, so nothing to stress me. He had already charmed his way into the office and had them smiling and nodding.  Twenty minutes of my time would be no skin off my back.  “Ok, let him in,” I said. 

Minutes later the young man walked in and introduced himself as “Kevin or Kev if you like”. He thanked me for seeing him on a Friday afternoon as he pulled out an envelope addressed to me.

Expecting to see fliers or pamphlets for a medicine I was soon to be convinced to stock and prescribe to my patients, I got an interesting referral note:

“Please see Kevin for discussion on his Patrimony and lineage wishes.  Clinical Summary; diagnosed with ocular tumor metastatic to his brain. All possible treatments have been given.”

Quickly getting over my surprise, I realised the ‘cool shades’ he was wearing were not out of his sense of fashion but a necessity.

Kevin, 35, worked with the National Libraries as Chief Custodian. He was a keen reader and loved all things books. He thought of his job not as a job, but a calling. Some four years earlier, he had started having vision problems and thinking nothing of it, changed the prescription on his eye-glasses severally. 

He was seen at various hospitals hoping to treat the headaches that came with blurred vision. Still, the relief he sought was minimal. Finally, he was referred to eye specialists where after extensive tests, he was diagnosed with cancer in his eye.  

He was advised to have surgery, radiation and chemotherapy, an unwelcome prospect which he quickly got over and ploughed through.

He had enucleations of his left eyeball and was fitted with a prosthetic eye. With ongoing treatment, he was declared cancer free a year and a half later. For nine months he lived his life fully, until the headaches came back. 

His doctors recommended a new phase of treatment starting with a PET scan and followed by twelve sessions of chemotherapy. The treatment was brutal but upon completion, he lived another year of relatively good health.

A few months earlier, he had started experiencing pressure in the left eye and heavy nose bleeds. He took off his dark glasses and showed me his artificial eye. It was clear eve to a casual observer that something was definitely pushing the prosthetic out.

More investigation revealed metastatic cancer to the bones and the brain. Kevin was referred to palliative care for support as he received the next phase of treatment, the reason he was now sitting before me.

To me, his comfort and peace of mind were going to be our top priority. His spirits lifted immediately as he told me of his plan. “Well, thank you for getting straight to the point Daktari. I wish to start a family or make arrangements for it to happen in the near future”.

I quickly checked out his ring finger to assess his marital status.  No ring there! “So, are you married or planning to do so soon? This may be a conversation we need to have with the other party in the room,” I told Kevin.

Without missing a beat, Kevin promptly laid out the problem. “Daktari, my girlfriend wants to wait until I’m off all treatment”.  He went on, “I think we need to discuss it at length because I fear it might be too late if we wait.”

It struck me that Kevin did not fully understand his situation.

“Now that I’m not on treatment should I not preserve my sperm?  Is that possible in Kenya?” Kevin’s questions went from hopeful to desperate.

We needed to discuss his situation at length, I thought.  We needed to discuss the side effects of chemotherapy drugs, we needed to talk to his girlfriend to understand her fears and plans going forward, and we needed to talk about his terminal illness. I was acutely aware that Kevin did not think he was terminal. 

Could it be that he was subconsciously planning on children to avoid the stark reality in front of him?

I told him about sperm banking, a fairly easy and successful process.  It’s usually offered before cancer treatment to males who might want to have children in the future.

He ignored the BEFORE part of cancer treatment and excitedly asked that we immediately book an appointment to get his swimmers. Finally, we agreed that I have a conversation with his partner before booking the appointment at the sperm bank. A happy Kevin almost skipped out of the office promising to have Maria, his partner, see me as soon as possible.

Maria did not waste time presenting herself.  She let me know that she insisted on coming in for the consultation alone and that Kevin had briefed her about our plans.  The ‘our plans’ sounded accusatory, which is never a good sign.   

“Daktari, no! Don’t bother preserving the sperm, I will not use them, I can’t do that to my child,” she said quite firmly. 

“Do what?” I asked.  

“Put them at risk of getting cancer. Between you and me, I am done with this relationship, I no longer matter. Everything is about Kevin, nobody ever asks about me or my opinion, I am now just a caregiver...” Maria said.

The more she spoke, the more agitated she became, soon, she could hardly get a word out and broke down completely. 

It took her another 20 minutes to gather herself enough to give another emphatic NO! I could see caregivers’ fatigue written all over her face.

One day later, Kevin, still hopeful asked, “So, can we do it?”

One thing I was sure about - Kevin was not getting a baby now or in the future, at least not from Maria. I had many questions but answers to those questions would have to wait.  For now, we needed to work on him getting seamless support and coming to terms with his mortality.  I hoped Maria would be with him to the end ...