House: The One Year We Lived at Work 9.

 

I was reminded by Dr. Adedotun that I did not rate Surgery department. My apologies.

Surgery rotation rating

1. Percussion: 5
2. Hands-on-skills: 4
3. Patient satisfaction: 8.5
4. Morbidity and mortality: 6
5. (Non)Toxicity of learning environment: 5

Total: 59%

 

I am back…

I know this series should have resumed a long time ago but you won’t blame me so much when you are done listening to my explanation. So, the lady decided to go home and she discovered that ‘three square meals’ still exist and that one can sleep all the night without one call phone going off or some nurse calling one to come reassure a patient that the hospital bed is safe. Nah, that was too much enjoyment to pass over. Besides, i was trying to sort out the issues with the site and…okay, okay, I should have come back earlier. Sowwy. I am back now and we are diving straight into INTERNAL MEDICINE.

 

Internal medicine

I’ll tell you why most people do not like Internal medicine. In fact, I am sure you already know why. Those people in Internal medicine can pick your brain for ‘stuff’ till you are only left with threads in your skull. Those guys want to know what you know, what you do not know, what you do not want to know, what you want to know, what you think you know, what you do not think you do not know and while they may get pissed at you if you are dull to percussion, (that is, a coconut head), they are more interested in ensuring you leave their presence never the same. You cannot be with a physician for more than ten minutes and not learn something; either something you have known before or something new. You cannot leave a medicine ward round and not wonder, “So, wait o, what do I even know?” You go back, read, face another ward round and you still look dumb as hell. Nah, those guys read and read and when they stop reading, they read again.

This love for ‘stuff’, (that is, book knowledge), and ‘percussion’, (that is, beating the knowledge out of you), is the supposed reason why some people think their patients die. (I think this is the first time I am even attempting to define stuff and percussion and that is because internal medicine is the epicenter of those two things).

There is the idea that a physician can keep moving stuff while his patient gasps for breath. In fact, they may not be doing anything for the patient on admission but for reasons of teaching and being taught, the patient is still of immense value. Compared to the surgeons, physicians are …’slow’. They don’t seem to know what it means to have emergencies.  All physicians care about is which stuff is the most recent and what reference for the stuff is superior and, trust me, they can argue these on their ward rounds for hours and at the end of the day, they may not reach an agreement on the best plan for the poor patient. I saw that happen.

 

Not the entire truth

While some of these things are true, the first thing that is wrong is the insinuation that medical patients die because physicians move stuff a lot. No, baby, no.

I don’t think this blog is enough of a platform to discuss the typical African/Nigerian attitude towards health and illnesses that do not bring immediate pain or discomfort, attitude to diseases that are not like malaria that require taking drugs for just a few days and and the attitude of not confirming with their doctors that they indeed have been cured of their chronic diseases when they get miraculously healed by their God. Even the lepers Jesus healed in the Bible were told to go show themselves to the priest who was the one to confirm them cleansed. I will try to illustrate how this poor health seeking behavior/attitude is the reason why most medical cases come in late, come in often/are admitted often and have poor prognosis and die more than surgical patients. I hope you get the picture I’ll try to paint.

Most medical cases are not ‘one-timers’; Hypertension, peptic ulcer disease, diabetes, asthma, stroke, myocardial infarction (known as heart attack), obesity, HIV, epilepsy, mention them, those guys are not things that just spring up in a day and in the same vein, they do not just go away in days or weeks. They are chronic diseases and with chronicity comes issues of drug and clinic compliance. With it comes the false feeling of wellness after initial acute exacerbation is dealt with. With it comes relapses and remissions and swinging moods.

Chronic illnesses are very hard to adjust to and manage

The mere 5-7 days antibiotics that some of us are prescribed for some infections are mostly skipped, missed, tossed under the chair, flushed down the toilet and totally forgotten once the individual feels better. Now imagine taking two drugs twice a day, at specific times… forever. Imagine having to religiously take these drugs every day of your life. Imagine having to go for clinics where you spend hours sitting before getting attended to, only to know whether your blood pressure or blood sugar is well controlled based on the drugs you are currently on. And then imagine you have gotten used to some drugs, then, your doctor thinks you are not doing so well on those and goes on to change your drugs and the routine you are used to is suddenly scattered again. Imagine your church members coming in with testimonies of how God healed them of a disease and they were back to normal within weeks and you are there, feeling like urinating because one of the anti-hypertensive drugs you are on increases the number of times you need to use the restroom and you already inconvenienced those sitting beside you some minutes ago… for the same reason and the usher is already giving you sour looks.

Believe me, chronic diseases take a lot.

Chronic diseases; patient input is most vital

Now, physicians cannot follow you home to be on your neck to stay with your drugs, they cannot be with you at work to encourage you to eat so your ulcer pains don’t pick up again, they cannot be with you during Jumat to give you an encouraging pat while your bladder screams for relief. In places that work, they can call you occasionally to ask how you are, ask if you have used your drugs, they can even program prompts to remind you, but, the main work is with the patient! And most Nigerians/Africans do not consider their health worth working for.

The physician at work is to deal with emergencies, relapses, deteriorating cases and palliation and the theoretical aspect of prevention. Taking the steps, following the advice of the doctor, looking out for danger signs, avoiding triggers, working your way back to normalcy are things that the individual has to be keen on, has to be personally motivated about. But, like I tried to paint, it is hard and most times, people slack. They forget. They purposely ignore. They think aal iz well. Then, there is a serious relapse and they are at the brink of death. If they are lucky, they get rushed early to the hospital; a hospital that has enough hands and functioning equipment to reverse the damage already done and prevent more from happening, they are revived, monitored and after recovering well, they are counseled on what must have caused the relapse and how to prevent it from happening again before they are discharged and are asked to come for follow up clinics. That is what happens if the individual is lucky. If his/her village people did not mean it to kill at that time.

 

Bad health seeking behavior plays a role

On the flip side, when things start going south for some people, instead of going straight to the hospital, they are taken to quacks or spiritualists who give them concoctions or drug cocktails, isolate them, charge exorbitant prices and give fake reassurance to the relatives and then when things start smelling like death and looking grave, they push them out to go elsewhere. Then, some enlightened friend or neighbor or family member that was initially not around, angrily drags them to a proper hospital. Problem is, at this point, there is the actual disease to deal with and then the effects of whatever wrong treatment they got from the first place they went to. Then, they usually come at the oddest hours when few hands are available to give the best care. Then, God help you the machine needed is not functioning or it is but it is the only one available and some other fortunate fellow who arrived earlier is already connected to it. We then ask the relatives who came in their numbers to rally round and get some medications , only to look around to find out that all others have disappeared, leaving only the secondary school leaver child of yours to do the running around and she has only N500 with her. Physicians will try their best and push themselves to save such people. They will stay up all night watching vital signs and giving medications, they will even contribute money from their pockets and wallets for the patient but the chances of survival are slim.

Yes, sometimes, physicians are not proactive about patient care, they may sometimes get carried away trying to analyze the pathogenesis of the disease per individual, but they do not desire their patients’ death and they do not get used to patients dying! I hope to still be able to talk more about this later.

 

Resuming internal medicine rotation

Meanwhile, I resumed Internal medicine and was informed that the department has morning reviews every day, except Mondays. The activities of the morning review varies but one constant thing is that questions are asked and answers are expected from the houseofficers upwards. That is, when a question bomb drops, it is often times first directed to the houseofficers who if unable to answer may be given the question as assignments or presentations. (This thing never gets old, right? And what is the efficacy? Lol, some other time, we shall discuss.)

So, I’m seated at my first morning review, trying to be as invisible as possible and learning names and faces of those I’ll be working with. I was taking note of those that were prone to asking a lot of questions, those that rarely asked but when they did, their questions seemed like they were taken from the clouds, those that asked questions only to answer them by themselves and those who said they had questions but ended up just… talking and talking and… arrghhhh. I was seated beside Dr. Lawal Abisola (I think God just used this lady to pamper me. She always went ahead of me to postings and was able to show me round and help me settle down in the new place.) And I was feeling a bit safe. I mean, I was the new kid on the block, they should be merciful and just let me be.

Loooooool

First question came and it was a ‘list’ kind of question, so, it was being passed round as each houseofficer was supposed to say something. Praise Be, I was able to say something… something right. Then, there was a question that needed an explanation of the relationship between two things.

“New girl… what’s your name? Where did you finish from? Answer the question.”

Praise Be, I gave an answer good enough for the question asker.

Then another question came and at this point, I had realized that being new was no immunity. In fact, in my case, it was spotlight. I’m thinking they were so glad that some ‘new meat’ had joined the department… new person to percuss and ask to move stuff. Before I knew what was happening again,

“…that girl from UCH… you seem to know stuff… answer the question.”

That sealed it. Once there is a public declaration that you are a product of the College of Medicine University of Ibadan who knew stuff, there was no escaping it. People all over would want to use every opportunity either to confirm it or dispute it. Oh well, I was not bothered. The same way I survived UCH, I would survive this. Once I do not know, I do not know na ni. Somebody cannot come and kill me for my mummy. But, internal medicine had more in store for me, little did I know.

 

Nostalgia

I was aware of the units in the department and yours truly, I already knew the one I did not want: Neurology!

The brain is a complex body organ. I remember the days of brain cut up in neuroanatomy. We would go to the lab and be put in groups. Each group was assigned a brain and we were meant to slice them up to view the different sections and learn the parts thereof. If you have never seen the brain live before, it is a soft, greyish white, convoluted organ with veins and arteries running all over it. If you hold it too tight, you can actually crush that part you’re holding. The different parts of the brain controlling our bodies, senses, other organs are not exactly well demarcated. In fact, to me, the most well delineated parts of the brain are the ventricles (these guys ensure the fluid cushioning the brain and spinal cord, ‘cerebrospinal fluid’ flows smoothly and does not build up). At least, you can easily point them out but even these guys can get mixed up. Summary is that, I am not sure I was following the whole slicing up brains thingy then. I had enough struggles handling the respiratory effects of the formalin used to preserve the brains, I was not so enthusiastic about trying to know which parts of the brain were grey matter and which were white. Like I said, the whole brain looks greyish white. Durrhhh.

Then, what of all the different and sometimes overlapping functions of tiny parts of the brain and the way those things never seemed to stick in my brain. My own brain that was supposed to be complex and do complex stuff o was finding it hard to understand… the brain. Add to all these the fact that in all my medicine rotations in medical school; 1, 2 and 3, I never went to neurology. So, it was like the universe was agreeing to my aversion to neurology.

 

That which I feared befell me

And even though the plan was to teach us all of medicine no matter what unit we were in, I am not sure how much of neurology was actually taught. And this is not entirely my fault. Truth is, even other units were not so conversant with neurology stuff. Of course, a cardiologist is meant to be well versed in cardiology and know a thing or two about other specialties. But, the one or two things a cardiologist knows about, say, endocrinology is like times three of the one or two things he/she knows about neurology. So, when it came to teaching us neurology stuff, it was usually, ‘So, I will give a brief overview of what we would be discussing while you guys go and read up the rest. You better read it cos you are the ones that will be discussing the topic.”

I’m like, “Am I a joke to you? I said I do not know something… that you should teach me. You are telling me to go and read it up. Talmbout how if I read it first, it reinforces it in my head. Oga, gbo’ju. Just say you don’t know it too. Warriz all this brain shaming you are trying to do? “

We would go and read o, at least the one we understood. Then, come for the so-called teaching. Some of them actually tried and it showed that they had good understanding of neurology but you see the others? reinforce kee you there.

So, my knowledge base of neurology was poor and if care was not taken, I was out to disgrace myself if I ended up in the unit which I eventually did. More talk about it is here.

I am wondering which of the cases I saw can be shared. Let’s see…

 

A Little Note:

1. Big thanks to the five guys who followed my blog between 25th of December, 2019 and 1st of January, 2020. Readers, for now, the benefit of subscribing is for YOU. It is still free for now. Please, do the needful.
2. HAPPY NEW YEAR!!! This year, I am committed to dishing out entertaining, information-laden and educative write-ups.
3. I am thinking of starting a Vlog (Some readers have mentioned imagining reading my posts with my voice/tone). Do let me know what you think of the idea. Merci.