House: The One We Lived at Work 13.

KNOW THE DIFFERENCE BETWEEN READY AND AVAILABLE. IT SAVES LIVES.

 

In our wonderful Nigerian system, an equipment or requirement is only available when you can confirm that you saw it with your two eyes and maybe even touched it with your hands. You have to be the doubting Thomas of the group, especially as a houseofficer. Also note that, yesterday’s availability expires with yesterday. Once a new dawn breaks, you have to reconfirm availability for that day.

It is terrible that this anomaly has now become the new norm.

The blood bank is the best illustration for this.

When a patient either donates blood or has blood loaned for him or her, a sample of the patient’s blood is sent to the blood bank so that it can be cross matched with whichever blood the patient would be getting. Truth is, the blood donated may not be the one to be transfused due to either different blood groups or other logistic reasons. Now, for this point, I would have to talk about loaned blood.

When blood needs to be loaned for a patient, the houseofficer has to be the one to go to the blood bank, with one of the patient’s relative and the patient’s blood sample. The doctor  has to be mentally and physically ready to battle it out with the scientists and interns at the blood bank because, like I earlier said, those guys just want to drink blood.

I see the whatsapp statuses of fellow houseofficers relating their similar struggles with blood bank staff and I’m weirdly comforted that it is not limited to my locality.

In some sort of fairness, it is not their fault that blood is not something we readily come across, seeing as most people reading this episode have never even donated blood before (just try and lie there, let me catch you). So, they have this ‘divine’ mandate to be watchmen over the pints of blood in the hospital and have to find a way to circulate the stock evenly among the different departments and the different cases, whether elective or emergency. It is a herculean task.

PLEASE, DONATE BLOOD. YOU CAN WAIT TILL WORLD BLOOD DONOR DAY OR JUST RANDOMLY WALK INTO A HOSPITAL AND TELL THEM YOU WANT TO DONATE.

At the same time, these guys come across like they actually want to deliberately frustrate you. So, you have to go there ready to fight. Ija wa, ija o si, always what? Always guiding. There is the option of becoming friends with one or two of them so that you get some kind of good treatment but they run shifts, so, you can’t  be assured that your ‘friends with benefits’ will always be there.

FILLING FORMS AND BOOKS JUST FOR SHOW.

 

When they finally agree to loan you this blood, a form is filled indicating the units of blood and for which patient and under which consultant. You also fill a book where you write your name as the doctor that came to loan the blood and you put down your phone number.

Why do we put down our phone number?

I’d think that this would be so that we can be promptly informed if things are not going according to plan as regards the loaned blood. That is, maybe the patient’s blood sample got missing, or the intended blood got used for someone else, or the cross matching is taking more time than it should or anything really that would, if not attended to, would impede patient care.

But, guess what, I think those guys take down our number just to have a ‘record book’ and then to call someone if the patient does not return the blood or pay for the screening tests. They’ve never called me before for that, so, I’d go with the other reason.

IN THEATER THE OTHER DAY… GOD SAVE US FROM EVIL IN THE MORNING.

 

This is why that interesting morning, the team had gathered in theater for three plus cases and were already done with one. We had sent for the second patient and no one was expecting any issues. I mean, one of my other HOs almost did not the hospital the day before just to ensure this woman had blood ready for the operation. Even though she had been told to donate blood weeks prior as her case was not an emergency, she hadn’t. Another problem we have with patients.

Readers, make true friends. Emergencies are emergencies because they are unexpected. If anything happens to you right now, can you count on three people who will be ready to put down blood for you? Family alone may not be enough.

If that woman did not have that operation that day, she would have to be shifted to the next operation day and that meant giving her fibroids more time to keep making her periods heavy, dropping her blood level more and more and causing other forms of discomfort.

And who knew what other more serious cases would be encountered in the coming week?

So, we loaned blood for her. She was to have a total of 3 pints as standby.

You can imagine the confusion we were all thrown into when the ward attendant came back from the blood bank with an empty container.

Apparently, “Dem talk say na only one blood dey for the patient”. Only one pint of blood available in the blood bank?!?

Okay. Hold on. What happened to the ones we loaned yesterday? The ones we almost did not sleep over?

Before we houseofficers could get ourselves to the blood bank to find out what kind of sorcery could have turned three pints to one overnight, murmurings of, “Who palpated the blood this morning”, were already going round among the senior doctors.

When I got to the blood bank, I was furious already but I decided to be calm and await some proper explanation. I met this alhaja woman who was very proud to tell me that, “that patient is not an emergency. They should not have allowed you loan blood for her, so, I ‘unloaned’ the blood.”

You did, what?!?

It was like they were hitting cymbals in my head. I asked her to clarify what she just said and she boldly repeated it to me that, “if I was around last night, I would not have allowed the loaning”.

So, patient is in theater now. You’ve unloaned blood, you did that without informing anyone on the managing team and you really think you are in the right. Wow.

It took the intervention of the consultants to get that woman what she required to be let into the operating room by the anesthetist.

Somehow, someone has to be blamed. And guess who? The houseofficers who stayed up late at night to ensure blood was available but did not palpate the blood in the morning.

RUN! RUN!! RUN!!! CATCH A BREATH AND… RUN!

Why do we like making matters difficult for ourselves? Well, lesson learnt and taken and now being shared.

In this place, (read: Nigerian federal and state hospitals), as a houseofficer, you really have to keep chasing after everything and everybody if you don’t want your ‘behind’ served for breakfast. Also note that you will be chased for what other people fail to do. In the end, you just find out that you are always on the run, literally and otherwise.

If you find yourself too settled, you may be sitting right on a trap. The mantra is, “Be a step ahead and get caught. Keep running and be safe.”

Which is why we fall.

 

“Guys in so so firm, you have a patient for caesarian section that has not been worked up for surgery. Please sort it out”.

This patient had not come into the ward as at  4 pm closing time. The norm is that patients for elective caesarian sections come in a day before the surgery, preferably in the morning so that materials and drugs can be written for them, blood sorted out and other tests taken care of.

We waited beyond that 4 pm, still hoping she would show but she did not. Being, the HO rep for the firm, I had allocated this patient to a houseofficer to sort out. But, she did not show up till we all left.

Now, it was around 7 pm when the message came in. None of us in the firm was on call. Working up a patient for surgery meant all I had earlier mentioned and then clerking the patient, that is, why she is having the surgery, how many previous pregnancies, how many deliveries, what route of delivery prior, what other conditions she may have, other previous surgeries she may have had due to some illness, what drugs she reacts to if any and then to take an informed consent from her for the caesarian section.

One of the HOs on call had agreed to do every other thing for us, except the clerking. I reached out to the HO who was in charge of the patient and he said he would have to go early the next morning to clerk her as his place was far from the hospital. I understood his plight but I also knew where we were. This issue was going to cause trouble for us.

I started getting ready to go to the hospital. My place is just some distance from there, I should be able to dash in, clerk and dash out. While still getting ready, the HO that initially volunteered to help sent a message that she had been told/ordered to leave the patient for us to sort out.

Yeap, that’s exactly what I meant. Trouble.

I got there. She had actually done most of what was needed. I thanked her, started the clerking, took the consent, tidied up what was left and got ready to go.

Some minutes to eight that night, I was hurrying out of the ward, out of my ward coat to begin the journey home. I remember the sudden disengagement of my right foot with the floor and the sharp twist my ankle made as I hit the floor, writhing in intense pain. I was, for a moment, lost as to what had just happened. In minutes, people had gathered, asking if I could stand. “Stand?!?! Man, I do not even know where my right foot is at the moment.”

A plastic chair was brought and I was helped unto it. Glad to be in trousers that night, I watched through half closed eyes as a patient relative tried to help me massage the leg. I was embarrassed and hurt but I had to go home that night. I had no intention of being bound to the hospital just because I came to clerk a patient. No way.

Well, I found a cab and got home.

Put iced water on the foot, took paracetamol and prayed that the usual would not be my lot.

The usual being that the leg would look normal at the time of injury and then hours later, it would swell up like garri ijebu and hit you with pain like you’ve never felt before.

I woke up the next morning, and, lol, I could not even get up from the bed. I knew I was in trouble.

This was more or less a sprain but I did not want to take any chances. Yes, I am an adult and my bones should not break from an ‘ordinary’ fall but who defines an ordinary fall again? I decided to go for an X-ray that morning to at least lay that fear to rest.

I called my chief SR to inform him of the injury and ask permission to be absent from the morning review that day (not from the whole day’s work o) and the first question I got was, “Is it that serious?”

After I got his permission to go for the x-ray, I literally crawled from my bed to the bathroom, likely used up whatever vocabulary of cuss words I know mixed with ,”Jesus, Oh my God, mummy” throughout the bath and dressing up and then limped my way out of the house, into a cab and took myself to the radiology unit.

I was on call that day, so, I was walking, scratch that, limping with my regular bag and my call bag as I did not want to waste time and go through the excruciating pain of first going to the call room and then going to the radiology department.

This was when I had to confront what most patient relatives have to go through and I felt so terrible. Of course, I am aware that the system is so backward and that a lot of time is wasted at most hospitals. However, having a first-hand experience made me understand better.

So, I had to first have my x-ray form costed, that is, have the cost of the procedure written on the form. Then, I was to pay a part of it at one side of the building while another part of it had to be paid upstairs. I looked at those steep, long, stairs and I had this intense urge to just sit on the floor and cry myself to sleep. I summoned courage and started this journey up the stairs and then down again.

Then, we waited. The seats were full, so, my limping self had to lean on a wall for a while till people were called in and space came up for me to sit.

WHEN ILL/INJURED, YOU BETTER LOOK IT. LOOK LIKE YOUR SUFFERING, ELSE…

 

I was able to get the x-ray done before the end of the morning review and while there was no fracture and my mind was at ease, it was too late to join the morning review and I needed to rest the foot. I decided to wait in the labor ward and that was where the SR I had earlier called met me.

He goes, “Is this not you? You don’t look ill/ injured. Look, you could even still use lip-gloss.  See how you sounded like you were dying when you called this morning. Are you sure it is not that you have somewhere to go today that’s why you went to fall down? Sha be going home.”

I could have gone home but I did not.

“Go home, rest and take care of your leg and yourself “is very different from, “Sha be going home.”

Many of my colleagues asked why I was refusing to go home. Some must have thought I was trying to prove strong head and some regs even thought I was faking the injury/limp that’s why I did not go home. They did not just think these things, they voiced them out to me. Of course, lathered as jokes and bants.

Thanks to my truly friendly HOs who were on call with me that day, I mostly sat down during the call and thanks to God, it was not such a busy one. Although, I still stubbornly stood up to serve drugs and help out with some other things because, I wanted to and I could manage to do those things.

One of the regs I was on call with was angry at me for staying back and kept saying if anything happened to that foot, it was all on me and she would not say sorry. Hehe, thank you, Ma. That was your tough love and you were one of those who genuinely cared.

 

The next morning, ready for another day of work, right foot even more swollen than before, a message comes in through the senior HO, from the chief SR;

“… houseofficers now decide to take sick off for invalid reasons on days they are to do call… this would be the first and the last time it will happen again… steps are being taken to stop sick offs being issued at the cooperate clinic  to OnG houseofficers…”

Well. There you have it.

What makes a reason valid enough to ask for a sick off?

 

Definitely, truly, most sincerely, there must have been people who took sick offs when they were not sick. Those ones, my God will judge them, because, they are indirectly responsible for this mess too. They are a contributing factor as to why there is now a blur between valid and invalid reasons.

But, listen, there is still an underlying problem/reason why people think they need to lie to get sick offs. It’s simple;

Till you are dead or almost dead, pouring blood like a fuel pump or gasping for breath, you may not be ill enough to ‘deserve’ rest.

This, while more seen for me at OnG, is not limited to that department. In fact, I think it may be a Nigerian/ African thing. If you have not suffered for it, if you’ve not shed blood, if you’ve not had to suffer ridicule and be deprived of basic human rights, you probably don’t deserve it.

This is very different from burning the candle through the night, it is not the same as making sacrifices. It’s more like you’re the sacrificial lamb and the priest.

This is why most people do not even know when they have a right to ask for some things. Many people feel they would be tagged lazy and irresponsible if they ask to be allowed to sort some family problem or attend to a sick child. “You are a doctor. If you can’t handle your family affairs without it interfering with your job, then, maybe this work is not for you.”

We put our lives on hold because the matter of our patients relate to life and death but when issues of life and death come up in our lives, nothing/no one is willing to be put on hold for us, not even our job, not even our colleagues or seniors. We are expected to put these things on hold too and let them resolve anyhow they want to, good or bad, completely or partially.

Really, the physical, mental/psychological health of doctors needs to be closely watched and improved on. We have become so used to neglecting our own health, safety and sanity to serve others that any doctor who attempts to do otherwise, is seen as unpatriotic to the Hippocratic Oath. Thank God for the modified version of it, but, aren’t we only seeing that clause on paper? Do we really have that at the back of our minds when we work?

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