House: The One Year We Lived at Work 12.

The estimated reading time for this post is 14 minutes

I Know You Missed Me. I Did Too. Welcome Back.

 

Even as I put on Chekwaa to start typing this part of the House series, I quickly muttered some prayers, “Dear God, I am only doing this because You gave me this gift and this series was inspired by You. Save me.”

Most of my readers would have assumed that I had gone into hibernation again. They’ll be like, “No worries, it is what she does. She will be back soon.”

But, my close friends knew it was not entirely true.

I was afraid.

The euniceoladeji.com is not a private blog open to just a select few. That would defeat its purpose to a large extent. Thus, it has a very wide viewership, including those that truly love me and those who truly do not and those who are just observers of both sides.

Also, it is not just open to my colleagues. It is open to those who have a level of authority over me and that includes my parents, senior colleagues in the medical profession (resident doctors, consultants) and pastors.

With my parents, there is nothing I have to hide from them. Whatever they do not know now, they probably have just not been observant enough or they have decided to turn a blind eye and I totally doubt that. As for the other group, God knows I am not supposed to be hiding from them.

But, the truth remains the truth.

Not everyone takes the truth in good faith. What I consider truth may be twisted into its negative form by someone who does not want such truth to be shared. The Knight always says what you do not say or reveal cannot be used against you.

No matter how genuine and harmless you intended your statement to be, it can always be misconstrued.

Some Good Feedback.

 

A dear consultant from surgery department followed this series right till the end of the write up on surgery. In his words, “I’ve read through, not skipping a single line of the first 8 series, though can’t guarantee I will be able to follow with such attention the subsequent series, haven seen to the end of your surgery posting…”

What followed was a sincere and heartfelt discussion with him that made me consider many things as regards my writing, the medical profession and the ills that ail her and the prospects therein.

He made me feel safe even as he pointed out the possible reasons for my stance with his department. He did not convince me against my attitude towards surgery but he reinforced the fact that there are still those who are the exception of the rule and also pointed out the fact that we, as houseofficers, do ourselves a lot of disservice when we do not apply ourselves.

“By and large… it’s been good reading those ‘feedback’… it makes me better…”

Maybe I should have used the, ‘No feedback is feedback’ Method.

Those were his concluding words. This humbled me. I am not sure you are reading this right now, sir, especially with the long break since the last episode you read. Still, I am very grateful. You did not follow the typical senior-junior medical colleague curve. I promise to keep your words in mind, God willing.

I can’t bank on having the same response or disposition from everyone.

While I am aware people have been eagerly waiting for this part of the House series, I am not certain I am writing this with my whole heart. A lot of ‘what ifs’ have been running through my mind and phew, it got overwhelming at some point.

I told myself, “Wait till you are signed out from the department”. That happened and then I changed it to, “When my forms are signed at the HCS office. I will write”. Then, you know what? “Why not get your full license first?”

But, man dies only once, right?

I considered putting a post here saying, “Due to better undisclosed circumstances, I have decided to not write about the OnG department” and leave the readers to conclude anyhow they deemed fit.

But, here we are, right?

Let’s start with something I penned down on one of my last days in the department;

“In this place, ‘humbility’ is the way out. Anything and everything you say or do or don’t say or don’t do can be held against you. If you don’t know how to pray, know how to charm. Our Father who art in heaven… Lead us not into temptation and deliver us from evil…”

Finishing a rotation on these terms says a whole lot about how it went. With all my talk and words about the surgery department, the obstetrics and gynecology department trumped it all.

Reputation Cannot Be Hidden.

 

The reputation of a department spreads far and wide, whether it be positive or otherwise.

Reputation: It travels with the winds, mixes with the waters running in the hospital and is carried by the grains of sand sticking to the shoes of those who tread similar paths.

On resumption for house job, I wanted to start with obstetrics and gynecology mostly because IbiBaby was there and I thought it would be nice to have similar schedules. (Thank God we didn’t. Can’t imagine both of us facing the same things at the same time with no one left with enough strength to comfort and uphold the other and then heading into the next posting together, both not knowing what lies ahead. Nah. )

While in other rotations though, I kept hearing all sorts about OnG and in all honesty, they were not all bad reports. However, one side outweighed the other. You know which. It got to a point, I started dreading going there and then when I thought of how I was going to end housejob with OnG rotation, and I would shudder a little.

There were days I’d be like, “Come on, baby girl, if you could survive others, you can survive that too.”

Well, the day I burst into tears in front of the Chief SR when he was almost denying me and two others our terminal leave, I found out surviving the dessert does not mean you should look forward to hell.

Other days, I’d say, “Eunice, just console yourself with the fact that after it, you are done with housejob.

Hmm, till my last day of my terminal leave which equaled to my last day as a houseofficer, I did not consider myself free. I was being careful of what I said or did and even where I went. Am I not even still doing that? And I did not leave with the enthusiasm I had with other leaves. I just stayed indoors and recuperated.

I also told myself, “You are UCH, nobody can get you.”

This department made me realize that my emotional stamina is still as it was then. I do not know how to talk back or defend myself, I still withdraw into myself when upset and when angry/upset, I still cry. And while in other places, I was able to move on fast, here, I found myself having to make conscious efforts to shake off the negatives of the days before so as to forge ahead with the other days clear headed enough so as to not get trapped again.

All these can be pinned on the ‘Last Lap Syndrome’ where in, everything seems more of a struggle just because you are almost done. Even in races, the last lap is considered the vital, yet most tricky part of the race. This is where all the momentum you had gathered earlier can be lost in a puff and everything appears to be against you.

It is at this point, you really can’t afford to mess things up.

I vividly recall a discussion I had with some of my fellow OnG houseofficers during a call and we were trying to count how many ‘benign’ resident doctors we had in the department. At first, some of us had concluded that there was none, but, when we calmed down, we were able to sift through and pinpoint some.

Rather than make me feel better that we were able to even point to some, it just made me realize again that truth that where only few men exist, their existence is overshadowed and almost pushed to oblivion by those on the other side.

Thing is, this applies everywhere. It may look all terrible, but, there are usually those ones who add some color.

In the weeks preceding this write up, I have wondered if my observations about this department were peculiar to my locations. Can I, like I did for surgery, take a stance?

In my Alma Mata, there was this thing about MB part 3.

During the course of time preparing for this exam, which consists of pediatrics and obstetrics and gynecology, the students found the pediatricians harsh and too ‘disciplined’ for their liking, also known as organized and serious minded. While the OnG team were seeing as friendly, jolly, happy-go-lucky people who were not out to stress them.

Then, MB part 3 exam would come and we’d see that pediatrics had prepared us adequately for the exam and OnG well… the highest percentage of resits and repeats were because of them.

Hold On Though, OnG Definitely Has Its Positives.

I have a friend who is a BIG FAN of OnG who also finished housejob from FMCA. She is of the opinion that that is the department that prepared her well for NYSC and that most of her skills were picked up there. Also, she likes the passion the department has concerning their patients.

I cannot deny the truth in those two things.

Mortality in the department is almost never heard of.  At our morning reviews, we could have admitted over twenty patients during the weekend call and would have not even one mortality. This was not because some cases were being hidden or pushed between units, no. rather, we just did not lose any patient.

In my three months rotation, I only had to do a CPR once.

The patient was in her early sixties, suffering from some gynecological malignancy (ovarian). She was apparently well to do, well learned and a very sweet lady. I was not in the unit primarily responsible for her care but I had come to know her based on prior calls done and haven had to interact with her daughter who was almost always besides her, the two of them talking amicably and holding hands.

That night, I was about collecting blood samples from another patient when her daughter called out in alarm, “Help, she is not breathing.”

This was the longest CPR I ever did. Even if my reg had not kept asking me to keep trying, I would have continued. I did not want her to go. I did not want to lose any patient. Besides, her daughter kept saying, “no, no, no”, and I wanted to affirm that. But, she did not make it.

Any and Every Mortality Was a Serious Matter. No To Maternal Mortality!!!

 

There were other cases but they were so few and wide spaced that once they occurred, everyone knew, everyone wondered what might have gone wrong, especially if the patient was not a gynecological case. That is, the woman had died due to pregnancy related complications.

If there is any place where zero maternal mortality is a possibility, it would be FMCA, OnG department. Those guys take their pregnant women personal. Healthy baby, healthy mother is the watchword. Those doctors would go over and beyond for their patients.

There is no lie about that. It gives me a lot of hope.

Essential Community Doctor Skills.

 

Also, in the world out there, people place a lot of value on pregnant women. And that is not unexpected. That is one human being carrying two people, two destinies, two possibilities, two futures and all that. The survival of both is of utmost importance. Anything that threatens that should be promptly be dealt with by the doctor because they know they cannot handle it and if he/she can’t, he/she is not a competent doctor. Simple.

So, during service year, when one may be “… posted to a village where you are the only doctor for miles…” your obstetrics and gynecology skills are needed and must be adequate. Else, you will be ridiculed in the community and they won’t bring yam, ripe and unripe plantain, and bags of rice, live hens and the likes to your house. Nobody wants that, right?

If you did not take delivery of a baby and the placenta, manage antepartum and postpartum hemorrhage, preeclampsia, malaria in pregnancy, miscarriages, ectopic pregnancies and those other common things during housejob, you just might be in for some shock.

Thankfully, I saw a lot of competence in handling these cases and I was involved in the management of most of them.

I remember one call night. I was at the gynecological emergency and a woman was brought in; she was pouring blood from her vagina anyhow and was already so pale. She had gone for an abortion some place and those ones had been generous enough to leave some product of conception in her womb. This was preventing her womb from contracting well enough to stop bleeding. The Karman syringe used to suction out in cases like this was not functioning optimally and despite our efforts with it, the bleeding was not stopping.

This was like maybe my third call and I was already wondering if this was going to be a mortality. I mean, there was no other Karman syringe in the whole hospital. But then, a tall, dark Alhaja SR came in and two intrauterine catheters were inserted, bleeding stopped, blood had already been loaned from the blood bank and she was already being transfused, someone was already tracking her packed cell volume and  by the morning review of the next morning, she was stable. Bleeding gone.

Oh. And by the next day or so, another Karman syringe was in the gynae emergency.

On this Karman syringe matter, in medical school, the way we were taught about the syringe, I had imagined it would be something so handy that even we houseofficers would have theirs to use. I thought it would be something whipped out at the snap of a finger. Apparently. I imagined wrong.

This is something that should be an essential part of obstetric emergency care. Yet, it almost cost a woman her life.

What In God’s Name Happened to Emergency Care?!?

Actually, in this one year of housejob, I have come to reevaluate the definition of ‘emergency’. The things medical school taught me to view as emergency cases were not met with the speed and immediacy I had imagined. This is by no means the fault of the healthcare team but mostly due to them being handicapped by availability of manpower, funds, theater funds, blood, drugs and other things that the patients/patient relatives have to make available before work is commenced.

Imagine a case of ectopic pregnancy (that is, the growing baby is located wrongly) and I had to be begging the guys at the blood bank to loan us 3 pints of blood. These people were there first telling me that blood is not available, then, that they can only give me two pints.

If you could first lie that there was no blood, then whip out two, how am I to believe that the third is not somewhere there and you are refusing to give it to me just to prove some point I don’t understand and maybe to be able to tell your wife at home that, “babe, I saved another pint of blood for you today”. Vampiric lot!

How can the mention of a ruptured ectopic at hand provoke no urgency or sympathy from you? Nothing. Just the same non-chalant, gum chewing affect.

Now, the obstetrician is ready, the peri-op nurses are on standby, the porters are ready to wheel the patient but the anesthetists won’t take the patient into theater unless those pints of blood are ready and available.

Oh, ready is very different from available.

If you have not ‘palpated’ the pints of blood a patient needs for a procedure, you are more or less dining with the devil.

 

A Little Note:

  1. Thank you for your patience with #PEO and the blog, euniceoladeji.com, I hope to make it up to you with this last part of the House series and subsequent write-ups.
  2. I am opening up opportunities to feature businesses on the blog as a way of advertisement. The blog reaches 100 people daily on an average and that includes viewers outside Nigeria. Looking for clients? This may just be what you/your business needs. It is not free but I am certain it would be comfortable for you wallets.
  3. My birthday is in five days. Want to do something about it? Drop your email and I will send you my birthday wish list and bank account.

Love.

#PEO

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