Author: mauweez

PR= 100b/m, BP= 200/100mmHg, RR= 30c/m, Temp= 38℃, O₂ sat= 85%, states nurse Agatha, as she hurriedly updates me on Mrs Eze’s vitals. Get me the sonicaid fast! Take off any tight fitting cloth or jewelry she has on. Commence 0₂ via nasal prongs at 4-6L/min, I quickly instruct the other nurses. IV lines secured bilaterally using wide bore cannula then blood samples obtained for urgent laboratory workup (GxM, PCV, VDRL, HBSAg, HCV, HIV, & liver enzymes). I quickly constitute IV hydralazine and give slowly over 10-15mins.

Commence MgS0₄ using Pritchard’s regimen. I instruct Nurse Agatha as she hands me the sonicaid. I attempt to determine the FHR (Baby’s heart rate) but couldn’t get it anywhere across the entire gravid abdomen…sadly, this has become a case of an IUFD (Intra Uterine Fetal Death)…baby was gone. I then turn to Chief Eze and explain my findings to him, then once more recommend an emergency C-section as the lie was still transverse. To my utmost surprise, Chief Eze had no objections, he signed the consent form without fuss.

Inform the Obstetrician/Anesthetist I instruct a nurse hurriedly and prepped Mrs Eze and the OR for surgery…shortly thereafter, we scrubbed in. 45mins to an hour later, Mrs Eze was wheeled out of the theatre to the recovery room, sadly however, the baby was gone, despite all attempts at resuscitation. The baby’s corpse was handed over to Chief Eze, who just stood there looking stunned. Thankfully, Mrs. Eze made a full recovery and was discharged home a couple of days later on her post op meds and was scheduled for her follow up appointments.

…THE END

Q&A

Q. what is cesarean section?

A. C-section is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus.

Q. what are some of the medical reasons for CS?

• prolonged labor
• Fetal distress
• Abnormal positioning
• Birth defects
• Chronic health conditions
• Repeat CS
• Cord prolapse
• Cephalopelvic disproportion (CPD)

Q. which is more painful? Vaginal delivery or CS?

A. Most people experience more pain following CS than vaginal delivery. Also, CS has a longer recovery time compared to vaginal delivery.

However, this isn’t always the case, as some vaginal deliveries end up with severe complications and prolonged hospital stay as well, even in the best of centers.

Q. How long does C-section take?

A. typically 45mins. It however also depends on any attending complication which might have led to the section in the first place.

Q. How long will I stay in the hospital following CS?

A. typically patients are discharged home 3days after the day of the op (i.e 4days)

Q. can I try vaginal birth after CS?

A. Yes, especially if adequate child spacing is practiced. Typically 2years and above for a VBAC (Vaginal birth after CS)

Q. Is CS painful?

A. You won’t feel any pain during the surgery following regional anesthesia. You may however feel some pulling sensations.

TAKE HOME POINTS

• Most pregnancies end in successful vaginal deliveries. A few however, present with complications which may require intervention for a successful delivery. Whichever group we fall into, requires us to arm ourselves with the necessary knowledge needed to make timely and informed decisions.

• Life is not a race, so do not compare yourselves to others. Go at your own pace because everyone’s path in life is different.

• If nature was to reverse the scenario making men responsible for childbirth, we’d probably be extinct in the world by now because absolutely NO MAN! can survive the changes that comes with pregnancy, labor and delivery. So to the men, support your wives, appreciate them, care for them and thank them for the sacrifice and miracle of childbirth.

…til next time, have an awesome weekend guys!

…I am Chief Ezeokeke Pius, CEO Ezeokeke and Sons global Ltd, KSM. The bulky looking man in front of me says. He’s got to weigh over 110kg I thought to myself. Good morning sir, I say, and welcome. Chief Eze, he says and beams with pride…call me Chief Eze. You are welcome chief. I requested to see you this morning to update you on your wife’s condition so far.

Mrs Ezeokeke seated here is a 24yr old G₂ P₀⁺¹ (meaning she’s a pregnant lady who had a miscarriage in her first pregnancy) who is currently Postdate (pregnancy has passed her Expected Due Date), she presented today as an unbooked case who is said to have been receiving care at home by a Traditional Birth Attendant (TBA)…”in Nigeria, very few TBA’s receive any form of training”. After examining her and with some laboratory investigations conducted, these are my findings chief:

1. She has what we call Pre Eclampsia ( her BP is 190/110mmHg, urinalysis revealed protein ++, and she’s got generalized edema)
2. There’s fetal bradycardia (Baby’s heart rate is lesser than normal)
3. Ultrasound scan conducted reveals a singleton fetus at term in transverse lie (meaning one baby lying sideways) and Fetal distress as well (slow heart rate for the baby)
4. Her PCV (blood count) is 30% which isn’t ideal.

Based on these finding chief Ezeokeke, I’m recommending an emergency C-section. We plan to admit your wife now and start her on some medications to prevent her from progressing to Eclampsia (convulsion in pregnancy) and to attempt to control her BP. We’ll also need to get a few pints of bloo…waaaaaaaait dokutor! Yells Chief Eze interrupting me.

You mean to “teh me the leason you cor me here this moring is to teh me you wan to opulate my wife”?(You called me here to tell me you want to operate on my wife?) God forbid!!! CS is not our portion!!! He yells. It is not in our family, he adds. Please calm down sir…eh…sorry, chief, I correct myself. CS is not a disease or a familial trait and if there was any other solution based on the circumstances I’d have recommended it. Chief, your wife has clear absolute indications to be sectioned and if we don’t act now, both hers and the baby’s lives are at risk.

“Dokutor, I say No”!!! Bellows Chief Eze, now sounding very angry and staring at me menacingly like he was about to pounce on me if I dared mention CS again. As I nor get power to fight, especially as chief Eze looked huge. I quickly pressed the bell signaling the nurse to come into the consulting room. As she enters, without allowing her speak I quickly say, “oh nurse Agatha, that woman in the ward needs me abi”? Nurse Agatha stares at me a lil confused but seeing the plea in my eyes quickly plays along, as a sharp nurse, lol. Yes doc, she says, your attention is urgently needed!

Thankful to Nurse Agatha, I quickly excuse myself and run out of the office to give Chief Eze a few mins to cool off before person come blow my eye, lol. As I’d heard stories of colleagues who were beaten mercilessly by patients whilst discharging their duties and that was one narrative I didn’t want to be a part of. A few mins later, I enter the consulting room with a senior colleague who was an obstetrician. I’d hoped that if he explained the situation, chief Eze might be more inclined to listen to him as he’s older looking and more experienced than my small self. Also, just in case Chief Eze decides to attack me I’d have someone to help prevent the merciless beating he probably had in store for me…thank you I’m a chicken, lol. I cannor comman die biko nu!

The obstetrician introduces himself and explains basically the same things I’d already said. Chief Eze however, remained adamant and continued to decline the C-section. My senior colleague then asked him to sign against medical advice, that we had no other option than to refer them to a tertiary institution as there was nothing else we could do here. Mrs Eze at that point started to cry and pleaded with her husband to listen to our advice, that she didn’t want her or her baby to die. That after all, they had been with mama for days now and despite all her efforts she couldn’t deliver the baby.

Chief Eze remained resolute and kept repeating “CS is not in our family”. His wife at that point, asked for the consent form, that she was going to sign it herself but chief Eze yanked the form from her and tore it up. He then asked her to get up, that they were leaving. Let us “try anoda hospitle” these ones don’t know anything!!! Shebi I told you to go to that maternity home beside the house and you refused! He says to the wife…ngwa nu, get up! Reluctantly, his wife gets up and follows him out crying all the way. That was the last we heard from them for the day. We attempted to call them on phone multiple times but the lines were switched off.

At about 7:30am the following day, a car sped into the hospital compound. I peered through the window and was surprised to see Chief Eze attempting to help the wife out of the vehicle and he was shouting “make una epp us oooo”!!! (pls help us). We rushed out to the parking lot and helped him place Mrs Eze on the stretcher. Check the vitals pls! I say to Nurse Agatha then I turned and asked Chief Eze what had happened. After we left here yesterday and went home, I called some of “my flends them” and one of them referred me to see one “mama at Ikeja”. I took my wife there yesterday evening and she promised us not to worry, that she can turn the baby and take the delivery safely.

We were there all through the night. “She massaged my wife’s tummy and put drip for her hand” he said. After some time, “my wife con say she dey feel weak and her eyes dey turn am”. (my wife felt weak and dizzy) Before I know she con convulse o dokutor! (she then convulsed doctor) The mama na prophetess, she con teh me say some people for my village dey fight me, say I go need to go for prayers. (The lady’s a prophetess, she informed me some spiritual forces were after me and that I needed prayers).

I con carry my wife go St Ignatius church for Ikeja. As I reach, the Fr there con teh me say I need to come hospitle. Say them go con pray for me for here as una dokutor dey work. That’s why I carry my wife come back. Dokutor abeg make una epp me!

…to be continued

“Ahn ahn dockie…you too dey sick”? This question has become quite a popular mantra heard, by all health workers (Doctors, Nurses, Pharmacists and Laboratory scientists even). Healthcare workers are considered to be superhumans and at such, shouldn’t succumb to illnesses like Malaria, stroke, Hypertension or Diabetes that other “mere mortals” suffer from. The funny thing is, after hearing this mantra for so long, some health workers actually start believing they’ve got some super powers…well, guess what? We don’t!!!

I recall a couple of years back, during my NYSC days, oh those glorious “Corper wee”!!! days. For those not familiar with it, I digress a little. The National Youth Service Corps (NYSC) scheme in Nigeria was established on the 22^nd May 1973 by the government of General Yakubu Gowon. It’s aim was to facilitate the reconciliation, reconstruction and rebuilding of the nation following the Nigerian civil war, so as to foster common ties amongst the Nigerian youths.

Now, right after camp, I returned home for a short break, like every other Corper, before reporting at my PPA (Place of Primary Assignment) where we were just 2 doctors in charge of 23 PHC (Primary Health Centers) across the entire local government we were posted to…this here, is a gist for another day, lol. Few days after my arrival, I noticed a spike in my Temperature 39℃ (102℉)…”Thank God nor be during this COVID-19 pandemic ooooo, choi”. I also developed an intense and persistent headache, generalized body pains and loss of appetite. And of course, this was followed by the tremendously itchy rash which eventually became fluid-filled blisters that covered my entire body. Holy shit!!! I said to myself…this is chicken pox ooooo!!!

CHICKEN POX (AKA VARICELLA)

Is caused by the varicella zoster virus (vzv) with an incubation period (from exposure to appearance of symptoms) of 10-21 days.

ROUTES OF SPREAD

• Airborne respiratory droplets (coughing or sneezing)
• Saliva
• Touching contaminated surfaces
• Skin-to-skin contact
• Mother to baby during pregnancy, labour or nursing

SYMPTOMS

• Fever, headaches, malaise, muscle aches and loss of appetite
• Rash (itchy and becomes fluid-filled blisters)

TREATMENT

• Contact your local health care physician…wink!

Back to my story then, lol. I had all the above listed info at my fingertips but my dear “blodas and sisters”, knowing and experiencing are 2 very different things! The hideous looking rashes were everywhere, on my face, in my ears, nose, mouth and places I can’t even mention…lol. Supportive measures such as rehydrating, applying calamine lotion, and using anti-pruritics weren’t doing much for me. And don’t forget, this was during NYSC where I was residing in a “5 star hotel…Not!!!” called “Family house”, I’m sure some of us can relate, lol.

We had to fetch water from a well (and the indigents would only permit us at certain times of the day). NEPA lived up to its name as usual (NEVER EXPECT POWER ALWAYS), which made the itching more intense and almost drove me crazy…I shit you not!!! And so, my wonderful fellow corps members who were certified “NOCTORS” (n. anyone who is not a doctor but acts as one) introduced me the wonderful world of bitter leaf and its uses. I was to bathe with it twice daily and  also drink it’s juice as well, twice daily, promising me that I’d become anew within 24hours.

Oh yes I felt anew alright but not the kind of new I wanted. I’m what you’d call fair-skinned and after bathing with the leaves, came out looking like a leopard (all the blisters became black…so I turned black and yellow!!!). One would think I’d learnt my lesson but apparently I hadn’t. The next noctor then prescribed another concoction for me to drink which I found a lil helpful, other than the fact that I’d always feel loopy after drinking it and also developed some diarrhea. I later found out the active ingredient in the herbal drink was lots of alcohol!!!…made sense now, lol.

 In the end, I got fed up of trials and errors from my Noctors and just decided to take my own advice and just wait it out with rehydration orally and some analgesia. About a week later (which felt like an eternity) I started feeling much better and the rashes finally resolved.

MY TAKE HOME

• Never ever judge people who look to alternative therapy (from licensed practitioners) when modern medicine doesn’t seem to cut it (Na person wen wear tight shoe know where e dey pain am).
• Healthcare workers aren’t super humans…take care of your health as well
• Listen to your physicians advice and try as much as possible to avoid Noctors
• Exercise, eat healthy and keep fit because a good immune system helps you ward off multiple infections
• Lastly, have a positive approach to life to maintain a good mental health.

…Til next time, have a good one.

May I have the folder please? “dem neva make any payment o doc” says the nursing assistant. please you guys need to make a deposit at the front desk I say to the relatives who suddenly start grumbling. what’s the matter? I ask, “we nor get any money here o dokita” they reply. ok, can you at least obtain a card with 1k so I can document my findings and what has been done so far? “gbo gbo awon private hospita yin gan, owo le ko ma ma be re f’un, e ti like owo ju gan, ahn ahn!” (All these private hospitals are too money conscious) one of them says. sorry I don’t understand yoruba pls, I say. “dokita, dey treat am go, we dey come”!!! another replies.

please nurse, can we open a temporary folder for Barr Gbenga please? “Hehn doc! these people nor go pay o”, she says. “make we just refer them now now bekoz me I nor dey for this kain work o” she adds. I got a piece of continuation sheet and started documenting my findings. “Doc, the RBS still dey show high o”, the nursing assistant informs me. how many pints of IVF has he had pls? 4L o she says. please we’ll require that soluble insulin now please, I said to the relatives, there’s a pharmacy just opposite the hospital. kindly get it from them so we can commence it for Barr Gbenga.

“wheech kain hospita be this one sef”? they yell, “una nor get am for here”? it’s currently out of stock please, I reply. “ehn make una go buy am na”! one says, “shebi una be hospita”? we go pay for e’fritin afta” he adds. Exasperatedly I ask all the so-called relatives who brought Barr Gbenga to the hospital, so none of you has any money with you? To get the soluble insulin (Actrapid) from the pharmacy just across the hospital? We need it urgently to save Barr Gbenga’s life pls…silence all across the room as if an Angel had just passed bye.

Okay can any one pls at least make some deposit? So we can see what to do about securing the Insulin? “Shebi mo ti so f’un yi wi pe ka ma wa si hospita yi (I told y’all we shouldn’t have come to this hospital)”…one of the female relatives mumbles, “won ti like owo ju ni biyi won o de mo ise, o ye kati gbe won lo ri baba (they’re only interested in money here and are highly incompetent, we should have taken Barr to see the herbalist)”. Excuse me pls, I don’t understand yoruba, can u pls speak in English? I say…“Ah say una sabi work for this place”, she replies…I just stare at her and keep quiet.

Laboratory results are ready. MP (+), FBC (WBC, Neu and ESR elevated, other parameters within normal limits), WIDAL (significant titre), SEUCr ( K+= 4.5mmol/L, Na+= 139mmol/L, Cr= 0.8mg/dl, Urea =3.7mmol/L), LFT also within normal parameters. Lipid profile not yet done. Can I pls get his wife’s number so I can speak with her? “080-tiri-5”…they call out the number for me. Hello, good evening, this is Dr Francis calling from Benson Memorial hospital, I then explained the situation to her and she pleaded with me to help in anyway I could, that she was currently en route to the hospital. she offered to transfer some money to my acct but I declined asking her to transfer to the hospital acct instead and she did that.

Pls call accts dept to confirm funds transferred by Mrs Gbenga I tell the nursing assistant and if possible to get the actrapid ASAP. “Dem say the money don enta but oga nor dey to approve release of fund”,  says the nursing assistant…I suddenly had a severe headache, God! Why me? I was supposed to be off duty today but had to locum cuz I needed the extra cash…choi, water don pass garri o. I tried reaching the boss, but his phone kept ringing without response. The meager 5k I was paid for the locum I had to give to the orderly to help me procure the insulin.

A short while later with Insulin in hand, the  treatment regimen was commenced as in management of HHS with hourly RBS check and IVF therapy continued. Pls also commence IV broad spectrum antibiotics I tell the nursing assistant 12hrly as I continued my documentation. After several hours and doses of the current treatment plan…Alas, Barr Gbenga opens his eyes and asks, where am I? Jubilation all across the ER and the relatives start dancing and shouting “praaaaaaaise da Lord!…Hallelujah!!!” Pls, let’s all calm down and allow the Px rest I say to them.

Just at that point, Mrs Gbenga hurriedly enters the hospital and is directed to the ER were she finds her husband conscious and improving. I then updated her on his treatment so far and what was expected next. That he’d have to remain on admission for the night, complete the treatment plan and when he’s able to tolerate orally and his BG is below 290mg/dl, he’d recommence his oral hypoglycemics. I then asked him when last he took his meds, it’s been over a week doc he replies. Mrs Ramatu told me about one baba who cures DM using herbal concoctions and urged me to try it. And so I had been taking the herbs for almost a week now whilst discontinuing my prescribed meds.

Mrs Ramatu it turns out, was the relative who was mumbling a few hours ago…u recall? I turned and looked at her and she pretended to be staring at her feet. In clear and crisp yoruba, I then informed her she was likely the one responsible for the Barrister’s condition, that being Africans,there’s always room for herbal medicine but it should be from those said to be registered with NAFDAC where the active ingredient, dosage and regimen had been crosschecked and that she was lucky he made it…Mrs Ramatu stood frozen, jaw dropped, cuz it suddenly dawned on her, I understood all they had been saying. I grinned, and walked away.

As I completed my documentation and treatment plan, I looked up and realized the other doc to take over from me was already around…and more importantly, my tummy growled more intensely now. I picked up my bag to leave as it was already pretty dark outside…and just as my day started, biiiiiiike!!! I hailed another okada man and headed on home. On our way home, it started raining heavily and just like that, due to the bad roads and lots of mud, the bike man and myself fell into a gutter by the road side.

Too tired to argue or shout, I looked to the heavens as if saying; what next? I got up, checked for any injuries…there were none, other than my badly bruised ego that is, and the hunger pangs that just wouldn’t relent and just walked the remaining distance until I got home. Had my bath and finally had a warm meal (I wonder what breakfast,lunch and dinner all lumped into one meal would be called?…Any ideas?)

As I sat there thinking about how my day turned out and wondering how Barr Gbenga was doing, I passed out and before I could say Jack…my alarm blared. I struggled to open my eyes, and realized it was already morning and I was to be at work in the next 15mins…I groaned and muttered, I wan be doctor, I wan be doctor…shebi u don be doctor now? Lubbish! And funny enough, I started laughing cuz when I think about it, I’d actually have it no other way…it’s a calling y”all…though better renumeration wouldn’t kill anyone yeah?…wink!

…Here’s where I drop the mic for now, put on my shades, and walk away, Lol…Shalom.

…I open my eyes and look at my timepiece, shit, I’m late. It seemed like I had only shut my eyes few seconds ago following a hectic weekend call. I quickly get ready and dash out, bike!…biiiike!!! the okada man looks at me and says, “ah dockie, hospital ba?” yes, I reply.

I arrive at work just a few minutes late, phew!!! no salary deductions today suckers!…I mumble to myself and grin. walking into consulting room one, I drop my bag on the seat, hoping to catch a quick bite as hunger dey wire me. as I rummage through my flat wallet checking to see what I could afford, the nursing assistant runs in shouting dokita! dokita!! emergency!!! she yells. My tummy growls, as if aware, it’s gonna be one of those days.

I quickly step into the emergency room and see a middle-aged obese-looking unconscious man lying on the emergency couch, with over 5 relatives in the ER. I check for a pulse, steady…regular. what’s his name? I ask. Barr Gbenga, one relative replies. Mr Gbenga! I call out, no reponse. quickly I assess his GCS, 6/15.

Nurse, get me a glucometer pls. what’s his BP? I never check am, she replies casually. I dash to the side lab, get the glucometer and check, RBS=High (I don enter, I say to myself). I quickly check his blood pressure 110/60mmHg. Get me 0.9% N/S I yell, and things to site an IV line pls. oh, and get the pulse oximeter as well, wetin be that? the nursing assistant asks. Forget it, I snap, not knowing how to describe it to her to make her understand. let’s set up the IVF first.

Tourniquet applied, I stare at Mr Gbenga’s hands, no single trace of a potential line-setting vein anywhere…why me? why today? I mumble. I reapply the tourniquet on every limb, no show. relatives shouting and crying dokita!!! do something oooo!!! where’s that house officers vein at again sef, I say to myself. I palpate the wrist, no show. I then check the cubital fossa and notice one tiny vein and I’m able to site the line…HALLELUJAH!!!

The IVF is commenced, rush 1L over 30mins, 1L over 1hour, 1L over 2hours and another Litre over 4hours. reassess the RBS hourly for now pls, I say to the nursing assistant. I get the pulse oximeter and assess his SPO2, 66%…shit! get me the oxygen cylinder! I yell. ah, e dey upstairs o doc, and me I nor fit carry am, e too heavy. I dash up to the 3rd floor, get the oxugen cylinder and run back downstairs. set it up (via nasal prongs at 4-6L/min) and after a shortwhile reassess the px’s O2 sat. now 86% and rising…thank God

I recall samples for further investigations had not been collected. pls get specimen bottles for FBC, MP, WIDAL, SEUCR, LFT and Lipid profile. Also lets pass a urethral catheter and open an input/output chart pls. when last did he take his meds? I ask the relatives. e nor dey take any medicine o, one replies, e nor sick since o. Hasn’t he been told anywhere before he’s diabetic? I ask. No o dokita, I just go check am for room this evening naim I see am for ground. who are you to him? I ask. I be oga house boy o dokita, he replies. what about his wife and kids? Madam travel o, and oga pikin dem dey school he says.

…to be continued