House: The One Year We Lived at Work 5.

 

At the end of housejob, I went to sign out with one of the consultants of that unit and he jokingly remarked that I came back so late to sign that the only thing he remembers of my time with the unit is how I cried that day.

 

A memorable patient

I’ll call him ‘C’. 7years old. Only son of his mother for the man she had just remarried.

Came in unconscious and if it were some place else, he may have been certified as BID… Brought In Dead. His mother was crying profusely. She , between loud sobs, told the story of how he had been ill for some time but she could not bring him in because she had been going around looking for funds. She knew that things did not go for free at the hospital and she was not going to come empty handed.

 

A quick stop at health insurance

I’ll use this opportunity to point out that our health insurance system is still not yet functional. I am not even talking about the millions that do not even know about it. I am not talking of those who have not registered. I am referring to the NHIS recipients I met at the FMCA. We would write a list of material for admission and when these recipients come back, we would discover that the pharmacist had selected just a few things for them and the other things would be left out. We had to specifically start telling these NHIS patients that, “see, if they do not give you all the things on this list at the NHIS pharmacy, please go to the general pharmacy and use your money to get the rest.” And what were the things we were even asking for? A pack of latex gloves and these guys would sell maybe just ten pairs. There was a time the 5ml needle and syringe they were dispensing was leaking and making houseofficers look stupid. Of course, they enjoyed not having to pay the N5000 for screening a pint of blood but how many of them required that?

 

 

Back to my patient

We received and admitted C and started work. He was swollen… ALL OVER. His liver was enlarged. His eyes were yellow. It seemed everything was wrong with him. It was a Herculean task trying to get the proper history from his mother likely because she was too distraught to think straight and maybe also because she was afraid. I learnt that fear makes the parents of sick children lie a lot and they sometimes do not even realize they are lying. The history then has to be taken over and over before a semblance of the truth is finally gotten.

 

What was wrong with him?

After the initial stabilization and resuscitation, we then had to ask the question, ‘what was wrong with C?’

To this day, I do not think we settled on one diagnosis. For me, I think we were dealing with a super bug that was resistant to all antibiotics. This super bug would tease us as C would start improving within the first few days of antibiotic use and then he would rapidly deteriorate again. We used all the drugs; went up to Meropenem (That’s like one terribly expensive, expected to be all-answering drug), came down to Penicillin G, used Lasix, stopped Lasix, tried all sorts for three weeks.

Finally, my last week in the unit, I remember telling the Knight that I was so glad about the improvement C had made. He was not as bloated as before and for a moment, I almost could not recognize him as the same boy rushed into the children emergency that night. He had started siting up in bed and was eating well. His mother was so happy and the team… we thought we had won.

 

I could not hold back tears

On the morning of the day he died, my last day in the unit, I went to the children’s ward to check up on him before going for the morning review. He asked for his mum and especially for food. I reassured him that his mother would soon be back and I was almost certain she had gone to get him something to eat. As I was about leaving, he clutched his head between his palms and cried out in pain. I rushed back to his side and he told me his head ached. I consoled him and told him to be patient for his food. He calmed down and I went for the morning review. Later on that day, I was told by my SR crush to go carry out an electrocardiography on him. I was excited to be doing this on my own, so, I bounded there, set up and started printing.

As I was packing up to leave, my SR crush and unit SR joined me beside him and while we were there, just generally commenting on the print out and the possible implications, one of them noticed that C was no longer breathing. It seemed like a bad dream. We started cardiopulmonary resuscitation and I remember praying and begging C not to die. I remember urging my SRs to continue the resuscitation and I vividly remember the moment we stopped and it all came crashing down on me.

C was dead!
C was dead!!
C was dead!!!

 

Emotions, empathy and …unprofessionalism

I remember the first salty tear tracking down my cheek and next thing I knew, my body was shaking with these tears I could not hold back. My SR crush drew me to himself in a hug and tried comforting me. He took me away from the ward as the other parents and children were staring. I cried my heart out…took a while to comport myself and when I finally came out to the ward again, there was no hiding my pain. As if to make things worse, his mother then walked in and seeing her dead boy, she lost it. Her words were deep in sorrow, regret and grief. She cursed all those who had snatched C from her as the typical Yoruba mother and wished them nothing good in life. She then turned to us, her son’s doctors and started thanking us.

Fam!!! The dam in my eyes burst again and I couldn’t take it. I walked and half ran out of the ward, promising myself that I would never let those tears flow like that again. Never. Later that day, my SR crush sent me some messages and one of them stood out,

“Keep that tenderness; medical practice and experience will try to suppress it… so, it is important to remain compassionate… that is the pattern of the Great Physician, our perfect example.”

Thank you, Sir!

So, if you have ever wondered if doctors have emotions, there you have it. We feel pain and our pain is deeper than you may ever be able to imagine. We see life take a spiral downwards and despite our knowledge, despite our care and all the efforts we put in, we see death win. When you see us laugh a lot, crack jokes, seemingly not looking like we care, those are our defense mechanisms. And as I have come to realize, those things are not even strong enough to shield us from the things we see and experience everyday. Till I left pediatrics, I was wary of stepping into the ward C was when he died. When I did go there, my eyes would go to the corner where his bed was and I’d shiver, steeling my heart from getting weak at its knees again.

 

‘C’ had motherly love

A special shout out to C’s mother. She went all out for him. She was not rich but she was not going to let anything stop her from providing all that he needed. She begged… her fellow parents caring for their own sick children, the other doctors in other units, passers by, strangers outside the hospital, by the main road. She was without shame when it came to getting money for C. She would wake up early to ensure she had water to mop his body. She would talk to him, telling him how sure she was about his healing. She would pray for him, every morning. Many times when I was on call and I had to administer his 6am drugs, I would over hear her praying over his sleeping form. They bore Muslim names but I heard her pray in Jesus’ name and many times, I caught myself saying amen to their prayers. When he regained consciousness, the prayers became call and response as she would urge him to say those prayers over himself with his own mouth. And when the drugs stopped working, she would get angry and cry and ask him why he wanted to break her heart and after a full chapter of lamentations, she was back to her cheerful self, consoling the both of them again.

Maybe it was the fact that C was her only tie with her new husband and if peradventure anything happened to the man, C was her only chance at securing anything from the inheritance. Maybe it was because she did not look like one to marry again, so, secured lot or not, she was nearing menopause and C was looking out to be the only child she would have to nurture in life.

Whatever her motivation, it was enough. She was a true mother.

 

The state of caregivers

With the likes of C’s mother in mind, I am often baffled at the other cases of children brought in for medical care. Most of these children were not half as bad as C was, yet, one could sense the nonchalant attitude of the mothers towards the children’s predicament. These women would be reluctant to purchase drugs, one would have to chase after them to ensure blood samples get to the lab and even after that, these mothers would still blame the child for falling sick. Don’t even get me started on the mothers that absconded after dropping off their deathly sick children. They would tell you they want to quickly withdraw from the ATM and that would be the last you would hear of them.

Sadly though, some of those children were Brought In Dead, so, there was really nothing to do. From my experience, most of the parents and relatives that brought in their children dead were already aware of the situation. They knew the child had died but they just… wanted to be sure? They needed someone to look them in the eyes and tell them , “we are sorry but the child has died.” That is the only way they can then allow themselves deal with the loss. Of course, there are those who genuinely still think there is life in the child and they are more difficult to deal with. They would go through all the stages of grief and their denial would be enormous. Breaking the news to either group calls for being delicate and cautious. You need to know those that would slump, those that would scream and rent their garments, those that would bolt for the door and into the streets, those that would seem calm until they start smashing things and be prepared for all of them.

 

The devil or the deep blue sea

While in the pediatrics department, I tried to debate within myself which was the better of the two evils, BID or death days or weeks after admission?

With BID, there is a truckload of hope that is crushed instantly with no time to gear up for it. At the same time, it all happens at once and one can easily …move on? For those who stay a while on admission, usually, there is time to brace for impact as there would have been signs of deterioration and the managing team would have been keeping them in the loop as to what is going on. So, plans can be made for whatever outcome. In this case, it is hope that has risen to its peak and then begins to ebb out just as life ebbs out of the dying child. It is protracted but expected. I think the BIDs have it… let’s all know we are not leaving with the child alive. Straight up.

But, looking at it from another angle, the BIDs of one hospital are the results of some other hospital’s other part of the debate. Or in the case of many parents, some other traditional healer’s home, some other pharmacy, some other neighborhood ‘nurse’, etc.

 

My experience in brief

So, there were tough times and there were magical moments. There were fun times like the end of the year parties. There were morning reviews that had the consultants shouting at us. There were days of joint buying of Iya Bash food. There were days when we were so stressed we could barely see the road in front of us. But in all, I am grateful to the pediatrics department.

One skill I am forever grateful to the paediatrics department for is the skill to site intravenous lines. Yeap. I gained that skill and I own it. Proudly. In fact, it is the main reason why there is really no line that intimidates me. Of course, if it proves difficult, I call for help but I never go in with the mind of, ‘this would be a difficult line’. Not anymore. If you want a houseofficer to acquire this skill, just send him/her to pediatrics.

Also, pediatrics offered the best welfare for houseofficers. The best. And this goes beyond physical welfare. They , and I mean the senior colleagues, were so understanding and caring. They were patient and had listening ears. They were particular about the comfort of their own. It was in pediatrics I saw houseofficers and consultants sitting together, discussing, making jokes and generally being free, without bringing in disrespect. It was culture shock for me, especially being from the great UI.

 

Paediatrics appreciation

At this point, there are some people I cannot but mention and send shout outs to.

• Dr. Alao… first SR I worked with and the only one who cared long and wide and beyond the walls of work. He knows his stuff and is humble about it.
• Dr. Oguntade… she is amazing. Works hard and laughs hard. Her hair is a cutie.
• Dr. Edokpolor… sweet Dr. Edokpolor. Till date, we still share memes and comment on each others whatsapp statuses. She is living proof that enjoying life as a medical doctor is a possibility and where everyone is running around in flats, you can strut in heels.

And even though she only really got to know me after I left pediatrics, here is to the Dr. Dedeke… passionate about her neonates and would tear into you if you by any means harm them.

 

My rating of the department

1. Percussion: 7.5
2. Hands on skills: 8
3. Patient satisfaction: 8
4. Morbidity and mortality: 7
5. (NON) Toxicity of learning environment: 9

79%.

 

A Little Note;

1. I really need to know your thoughts about this ‘first part’ of the series. What could have been removed or added? What could have made it better? This would inform what changes I would make to the upcoming parts.
2. I’m still putting the target at 200 views for this post. I am not backing down.
3. #Peo would be going on a little break tomorrow for Christmas and when she is back, we would be moving to the surgery department.

Love and Light.

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