House: Caring for Women in OnG.

Dear Husbands,

 

This brings me to another point. Men and women, listen up.

Husbands need to be there for their wives during pregnancy, labor and in the first few months after delivery.

These women have a stretch of 12-15 months in which they have to cater for some other entity that is not in any way contributing to their own well-being. And all of this by no fault of theirs. Or, at least, not entirely their fault.

We are not asking you to stop working or start picking up after them everywhere. No. Just be ready to do more and bear with them. Many women come for antenatal clinics alone. Some even drive themselves down to deliver. While, of course, there are days it would be tres difficile to be there physically, there would be other days where you can and you should.

Encourage them. Don’t remind these women of how fat and out of shape they have gotten.

This is not the time to remind her of her ‘days of slaydom’. This is also not time to subscribe for a fitness class on her behalf, unless she asks you too. The truth is, pregnant women are aware of these changes already. Consciously or unconsciously, they are making efforts to not let themselves go.

Allow them rest and if they would rather work, encourage them while gently watching out for when they are taking on too much or getting stressed.

Pregnancy is more than cravings. When some men speak, it is obvious that’s all they know about being pregnant.

Just One Time.

 

Like I earlier said, the OnG department of the FMCA has really gone a long way to ensure the safety of women and mothers. It is a feat worth celebrating.

While in medical school, we were warned about a condition in pregnant women that can lead to convulsions; pre-eclampsia.

It was described then in such a way that I, an ‘unpregnant’ woman, was scared of it. The woman’s blood pressure starts and continues to rise and the level of protein in her urine also rises. She can then start having headaches, epigastric pain, blurry vision, and other symptoms that are indicative of an impending convulsion.

Remember how I mentioned that hypertension has become more or less an every average man’s burden in our side of the world? Well, I then thought that this condition, preeclampsia, would be so rampant. I imagined that pregnant women would be convulsing anyhow.

I did three months with these OnG guys and I saw only one woman convulse while on admission with us. There were two or three who had convulsed wherever they were coming from but that was the last of it once they got to FMCA.

It was beautiful.

I remember checking some of their seizure charts and was immensely pleased to note that those charts were empty. And not ‘doctored’. W took care of our women.

This goes to show how using and enforcing a working regimen and adding other proper medical care goes a long way to right things that had gone wrong and prevent worse things from happening.

Brings to mind two cases of women who had this described convulsions after delivery of their babies at some outside facility. (Yes, it can happen before, during and after delivery and the best ‘cure’ is to just get the baby out). Both of them had serious kidney issues and needed dialysis.

By The Way… About Dialysis.

 

There was this tweet about all ‘rich’ Nigerians being one dialysis session away from penury. I sincerely do not pray it on anyone.

It is rare to have just one session and be fine.

But, not everyone is dependent on it for life or till they can have kidney transplants. But the truth is, whether as a one time thing, or more unfortunately, as for chronic use, dialysis is draining.

Oh. I just remembered this patient in internal medicine who pulled out his femoral catheter. Yikes! Thank God for the vigilant nurse on duty at the Cardiorenal ward. I was done attending to the patients for the night and was walking out to find food when I just looked through the window and saw  her frantically doing something at the patient’s side. I dashed in just as she was telling the orderly to call for me.

Come and see blood. This was when all those ‘Ps’ of securing haemostasis came handy. Firm pressure for some minutes and the bleeding stopped.

The man was delirious and had been asking for his urethral catheter to be removed. When no one was granting his wish, he decided to take laws into his hands and well, instead of yanking out the catheter and causing some urethral injury, he pulled the femoral catheter.

After I documented and informed my reg, I thanked the nurse for her vigilance and for listening to the ‘something that told her to check on the patient’ and asked her to keep an extra eye on him. A unit was saved from an extra row during morbidity and mortality meeting.

The first woman who had convulsed and was brought to the gynae emergency had a daughter that was looking so harassed. They had nothing left.

Well, except for those she called that night, who sent her the money for the dialysis. Without payment, no patient would see any machine to dialyze anything. That was the rule. Again, know and have people. Yes, know and have God o, but He would use people, right?

I remember my tall, bespectacled, funny but very stuffy, newly crowned SR having to give her some serious talk about the condition and prognosis of her mother if that dialysis was not commenced ASAP. Although, he was ready to stand in for them till they could get the payment done, the rule was the rule.

We do Not Pray for Some Type of Lines.

difficult lines

This woman was bloated. Every part of her body was accumulating fluids. Doctors reading this can imagine the horror of securing any intravenous access or even getting blood samples for tests which was very crucial to monitor her progress. But, somehow, I found grace to get the blood samples whenever I tried. And I became close friends with her because every blood sample was a ‘fight’.

She knew how important those tests were to her management as they determined whether she was going for more dialysis sessions and that meant whether she and her people would have to look for another 70,000+ or not.

She knew that the tests also meant how close she was to going home and spending less time on the hospital bed, eating hospital food and watching others go home while she could not.

But, having to be pricked to get blood several times was not easy. (I know severally is now in the dictionary but it still sounds weird, thank you).

So, she would protest in pain when the first attempt was not successful and talk about how we doctors just prick people anyhow and how we do not realize how painful the whole thing is. I would tell her but you know I have to take this blood samples and she would reluctantly settle down again. It was fun and at other times, frustrating because there were other things to be done.

Watching the Miracle of Healing.

 

But those times made me watch her progress closely. Soon, the back of her hand that was puffed up like over ‘yeasted’ buns were coming down and I could palpate her carpals and metacarpals again. Soon, her face that was puffed up like someone who had encountered SARS on a particularly bad day was now getting better.

And then the day came when I almost did not recognize her.

She was sitting out of bed, eating amala. I was taken aback and had to ask her, “se eyin niyen”/”is that you”?

She laughed and I laughed and I just took a few minutes to watch her and thank God on her behalf. This time, getting a vein was vite.

I felt like hugging her but, you know, professional yen yen yen. You see, the doctor is ‘afflicted’ by many emotions on a daily and to keep some iota of sanity is to know how to control them.

Someone still recently told me that, “You doctors are not fazed by death’. What was I to say? Patients see us as ‘mini gods’ and while they expect us to have human feelings, they really do not expect us to display them.

Has Your Patient Ever Surprised You?

 

Although, there was this other patient at the gynae ward, Mrs. Q.

Oh, typing about her is even so heartwarming. God bless you, wherever you are, ma.

She had an abdominal mass originating from her ovaries. This woman looked nine months pregnant with twins and her previously slender frame looked so burdened with the mass she had been living with. She could barely sleep well as the mass’ compression effects were making breathing difficult. Many times, she would have to sleep on the chair and place her head on the bed. Eventually, her surgery was done and she was recuperating. Thank God it was a benign mass.

Whenever I came to serve her drugs, she would ask, “My doctor, how am I? Am I getting better?” She was like a cute child, very curious, yet, very trusting.

I’d tell her the latest and what we were working on and what steps were next and she would thank me. Then, I moved to another unit, the gynae emergency, and I was not regular on her ward again except for call periods.

The first time I went back there and she saw me, she was so happy. I was content to just wave and smile at her but she had other plans as she drew me near and gave me a big hug and concluded it with a huge peck on my cheeks.

It was not like I had done anything spectacular for her, heck, I did not perform her surgery or even assist during it and even if I did, she would not have known. But, somehow over the weeks, I had impressed upon her that she had a friend in this doctor.

I was taken aback but also very pleased.

One day, she told me she had been discharged and would be leaving soon. I congratulated her and told her I may see her again before she left.

I did not. But, I’m glad that she is better because of the collective work of the team.

The Fruit of the Womb…

Infertility is a big issue for women. One which not much attention is being paid to. And In Vitro Fertilization is EXPENSIVE.

Imagine having to spend millions on something not 100% guaranteed to work. Imagine having to do that more than once because the previous time(s) were not successful. Then, imagine losing the child/children in the end.

Meet Mrs. J…

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