Escort-in-Chief: Neurologist's lessons in care, empathy, and brain science

Dr Bundi Karau is a physician and a neurologist. He holds a Master's in Internal Medicine and a Ph.D. in Neuroscience. Gardy Chacha caught up with him at Kenya National Library in Nairobi as he launched his book titled Escort-in-Chief. He shares lessons he has learnt about his field of specialisation, patient-doctor relationship, and the human short-comings doctors are all prone to.

As a neuroscientist, what kind of patients do you treat?

I treat patients with neurological issues, but I also conduct neuroscience research. So, I combine both aspects.

“How do neurology and neuroscience differ from psychiatry?”

Psychiatrists treat diseases without an organic cause – disorders of the mind or brain, which we call mood or psychotic disorders. Neurologists, on the other hand, treat medical conditions affecting the brain, spinal cord, nerves, or muscles. For instance, if someone has a brain infection, they would see a neurologist, not a psychiatrist. Conditions such as Parkinson’s disease, meningitis, multiple sclerosis, stroke, or nerve disorders are handled by neurologists.

How long have you been studying medicine?

I started university in November 2004 and completed my fellowship in November 2025. I’ve been working and studying simultaneously throughout that period.

You seem to love academics. What is it about them that excites you?

One, I like exploring new things. There are a lot of things which are not known. And one of the areas that remains undiscovered is neurology. The brain is very vast. It needs a lot of study. Usually, I like to say that you are who you are because of your brain. And it fascinates me the way it works.

The word ‘escort’ could be interpreted in many ways: what is in ‘Escort-in-Chief’?

This book is about a doctor’s perspective of patients and the journey of healing – for both parties. I come to the conclusion that in medicine, there is no heroism. All we do is escort patients through the fears of life’s journey. The book recounts my encounters with patients and the journeys we have walked together. My reflections led me to view my work as walking with patients. It is not about seeing them once and performing heroic deeds. When you walk with someone, you must develop trust, humility, and patience with whoever you are treating.

Does that mean the best doctors are those who do not see themselves as heroes?

Absolutely. Once you see yourself as a hero, you start to fail. You overlook small but critical details. During training, we are discouraged from making ‘spot diagnoses’ – seeing a patient and immediately declaring, ‘That is a heart attack.’

How does seeing yourself as an ‘escort-in-chief’ help patients?

A patient has a life beyond the disease they are battling. I have realised that when I become a good escort, even when a solution is not possible,  patients appreciate it.

Which doctor-patient experience in the book will always stay with you?

It is about a lady who had lupus. By the time she came to me, she had been visiting hospitals for five years, losing her hair, suffering joint deterioration, and experiencing skin changes, yet she had no proper diagnosis. When we discovered she had lupus, we agreed that this was a journey we would walk together.

During this journey, she underwent a double hip replacement because the disease had destroyed her hip joints. She developed high blood pressure requiring six medications and faced infertility. Over the years, her conditions multiplied. Yet we walked the journey together. She remains resilient, with a smile on her face – a patient who exemplifies the journey of a physician.

From my interactions with her, I have learned that being a good physician is like conducting an orchestra. You must know when a patient needs an orthopaedic surgeon, a kidney specialist, or a cardiologist. You must honour the trust they place in you by providing sound advice so they receive the right assistance at the right time.

It sounds as though there is an emotional and psychological toll to being a caregiver.

Yes. If you’re a good physician, you put yourself in the shoes of the patient. You imagine the various types of pain they are experiencing, and you handle them with empathy In the course of treating patients, we develop attachments. So, what happens when a patient slips through your fingers? Most of the time, it’s not a pleasant feeling.

How do you overcome that?

What keeps us going, particularly myself, is knowing that I’ve done all I could. I’ve given my best. I lay all the cards on the table and discuss everything openly, without hiding anything. 

Is there anything people can do to improve the health of their brain and overall neurophysiology?

Three things. First, follow what we call the Mediterranean diet: foods rich in animal protein, fibre, and low in carbohydrates. The animal protein I mean is mostly white meat, which is rich in omega-3 fatty acids – essential for the brain.

Second, exercise is important. It improves blood circulation throughout the body, including the brain.

Third, ensure good, uninterrupted sleep. The brain has a waste-clearing system, called the lymphatic system, which works only during sleep. Anyone who fails to get at least six hours of continuous, uninterrupted sleep accumulates waste in the brain. This is where degenerative conditions such as Alzheimer’s, dementia, and other neurological diseases often begin.

By the way, when you get sick, where do you go yourself?

I go to other physicians.

You don’t treat yourself?

No, absolutely not. Likewise, I do not treat my relatives.