Saturday, July 25, 2009


It's the weekend finally, looked earnestly to this weekend to take a break from getting up early and going to the hospital. This week started out slowly but ended up being quite eventful. It was filled with house officers being berated by their seniors left, right and center, rows breaking out between the team and a patient's mom and vehement abuse from a family who lost their mother.

Monday morning saw my return to the hospital after the week away at the conference. My assigned team wasn't functioning at full capacity yet so i tagged along with another team. Learnt quite a bit from this team and saw a couple of cases of diabetic ketoacidosis (DKA). The phenomenom of DKA is becoming a regular sight in the emergency ward. This is in consinance with the rising trend of diabetics in the developing world as a whole and Nigeria in particular. Diabetes in places like Nigeria is projected to rise many folds if something is not urgently done to reverse the trend in lifestyle. The traditional African lifestyle is less prevalent and a more western lifestlye and diet is becoming more favoured. It seems to me that ignorance plays no small measure in this being the case. It is thought by many that the bigger one is and the more (western) food they consume, the wealthier they are. This leads to many leading a life that isn't much good for their health. Moreover companies such as coca cola has played no small part in the rising incidence of diabetes. This unhealthy new lifestyle is a great folly and will spell doom for those that continue to imbibe it.

Tuesday came around, the team assembled together for a ward round. First patient: DKA. Management: Rehydrate, give insulin, correct potassium and suspect infection. We had issues getting lab results (for potassium levels) for this patient as some machine had broken down in the lab and there was no replacement (only for naija!). Next patient is a known hypertensive who takes his drugs on occassion. He presents with an adverse effect as a result. He reveals that his inability to 'perform' discourages him from adhering to his meds. The consultant indicates to the rest of the team that it is quite rare for a patient to volunteer information on why they don't comply. A decision is reached to change his meds to something more suitable. The next patient is a seventy year old man (the pidgin english interview) with pneumonia, he seems happy and is recovering well. We proceed to the female patients and start off with the sickle cell girl. Her mom is beside her as always sponging her forehead. Over the night she had had a sudden spike in her non relapsing fever and was given an anti malarial by the doctor on call. This didn't please the team much as they had decided to hold off on all drugs until the cause of the fever is isolated. This precipitated a heated disagreement between the patient's mother and the consultants. She accuses them of abandoning her and they accuse her of emotional blackmail. It went back and forth until the team finally leave saying they should be left alone to practise their medicine as they deem fit. If she (the mother that is) doesn't like it she should go somewher else. We move on to the next lady, the lupus sufferer. She isn't doing too bad and isn't doing great either. We spend a few minutes there and finish off the round shortl afterwards.

Wednesday consists of rounds around the same patients, less one, with no major development. Thursday sees the addition of one new patient on account of- you guessed it- DKA! Nothing unusual happens today except for the history i took, it was in proper english!

Friday is the same routine yet again with house officers continually berated. Same pateints are seen, this time the mother of the sickle cell patient is happier and effusive with thanks as her daughter had improved over the past few days. The labs blood culture came back positive when a prior result hadn't yielded anyhthing. The lab used a different technique the second time and grew a pathogen. The young lady was commenced on appropriate anti microbials and seemed to be doing much better. What a difference a few days can make, from being at each others throats to giving and receiving thanks. Life's just funny. As we stand in the corridor a lady and two not so gentle men came along ranting and raving for the death certificate of their mother.
Young man to nurse: 'you short evil witch, you killed my mother. You're evil, so evil'. The doctors try to placate him but their pleadings seemed an incendiary to him. 'You stupid people, you killed my mother, you're all wicked'. He accuses the hospital of neglect and labels all the staff as incompetent. The consultants become incensed by this behaviour and let out a few words of their own. The confrontation ensues until security is called. I walk up to the nurse afterwards to aplogize on their behalf as they were way out of order. She smiles and says i shouldn't worry, i'm a christian she says, didn't Christ suffer more than this. Her answer impressed me a great deal.

After everything calmed down we head to the surgical ward to do a consult. The consult takes a little time afterwhich another student on the team presents a case to the senior resident. I get roped in to do the abdominal examination which was abslolutely fine until the doctor says to inspect his inguinal region and groin. I do this with some hesitation and stop short of testing for testicular atrophy thank goodness.

Finally the day ends bringing to an end my 2 week experience in medicine. Now time for surgery, don't think i'll enjoy it half as much as medicine. I drive home by faith in torrential rain looking forward to the weekend.

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