A Doctor's "Secret" Health Notes

Hi, people. I'm on weekend duty and finally the work's a bit light now. Those two Road Traffic Accident victims have been transferred to the National Orthopaedic Hospital, Igbobi. The Ortho Surgeon thought it best for a better-monitored care over there. I've uploaded a new story on the "Training Day" page, titled "Passion Amidst Intensive-Care". Again, it chronicles my experiences this time as a freshly qualified medical doctor under intense pressure from the 3-months intensive-care posting I was under-going, refreshed though, with some moments of passion. Go to the page now and get the interesting piece.

Road traffic accident victims with multiple fractures just rushed in as an emergency about 3 hours ago.. The nurses are all set so I'm off to repair some of the wounds now.. ... I'm done suturing the extensive, multiple lacerations one of two victims sustained on his left upper arm and right leg. This young man also sustained a fracture at the neck of the right femur. The other man had worse injuries: multiple fractures, left Tibia and Fibula, and then a fracture at the distal end of the right Femur bone. He was in hypovolaemic shock when he came - he had bled inside his right thigh; the thigh twice the size of the left one - his blood pressure very low at 70/60 mmHg. Both are stable now and are being reviewed, even as I make this post, by our Consultant Orthopaedic Surgeon who came in an hour ago.

She's having it difficult, this patient on admission. The foetus in her womb is probably coping, though. Mrs Agatha has a Uterine Fibroid co-existing with a 26-weeks pregnancy and she has been thrice admitted in the last 2 months. And now the laboratory results prove she is Anaemic with her PCV count 25%. At least her vomiting is infrequent now. There is a bit of a drama as to whether she should get a unit of blood transfusion or not. And who's to pay for the transfusion. Us, she or her HMO... The matter would be soughted out between all parties; my maverick of a medical director never kin to give any breathing space to HMO's who appear to always assume that every manner of health-care cost must lie squarely on the shoulders of the health-care facility to which the patient is assigned. Ours is a Medical Center and we are barely surviving in the harsh economy of today.

I'm on a weekend break so I decided to up-load a heartfelt true-story involving me and my patient many years ago as a medical student. Read the story in the page, "Training Day".

Today, so far, has been boring. The labour case of yesterday went well - a baby girl delivered safely. Another woman is yet in labour. I ruptured her membranes earlier on. You rupture the membranes by introducing two digits into the vagina, find the cervical os and then guide your toothed forceps through, clamp, and with several tries the membranes are ruptured. I feel out of sorts today..

You can tell most times that a woman would have a successful labour, ending in a normal vaginal birth , after examining her digitally. I've just admitted this booked para 1 whose labour started earlier today and she's likely to deliver vaginally in about 8 - 10 hours from now. The cervix was paper-thin and soft like butter. Her pelvis seemed roomy alright and the baby's head nicely engaged. - sorry, technical stuff. I'll let you know how she progresses. Discharged the neonate with Sepsis today. Remember I posted in 2008 our very own Mid-wife with a first-time difficult child-birth? - scroll way down and you'll see the post - well it was in fact her second-born that had Neonatal Sepsis and discharged today. I didn't bother you with this detail earlier. When she became panicky over her sick child's condition, I had teased her that she would once again make an entry into the pages of this health blog!

The neonate is calmer today after an irritable night that worried the mum so. It's fever was indeed quite high all through the evening and overnight but much less now, thanks to the intravenous antibiotics administered 8-hourly. I've even allowed breastfeeding to start and so far, no vomitting again. A NEPA staff was attacked by thieves on his way back from work. His bleeding scalp laceration - he was stabbed on the head - was promptly sutured by Dr. Nsisi who also ordered 1 pint of whole blood for transfusion - Dr Nsisi wasn't taking any chances as the amount of blood-loss before arrival remained undeterminable; the patient already feeling thirsty and faint. Now, this man could have bled to death. His shirt was all crimson in front and a vein was continuosly spouting blood, I observed, the moment I entered the emergency room before Dr. Nsisi's arrival. Whereas the wound, though deep, wasn't large in area and so simple pressure over the gushing wound before arr...

A very early phone call woke me announcing the illness of a neonate with the voice on the other end quite worried. The worried mother hung-up and soon arrived the hospital within the hour. Neonatal Sepis. This was the diagnosis. Neonatal Sepsis is usually of bacterial origin and afflicts babies aged 2 months and under. The chilld had flu -like symptoms. Probably, an airway infection must have led up to Neonatal Sepsis in this case. With the child already vomitting breastfeeds, the mum was in near- panic . More later.

I've just been informed that our scheduled Caesarean Section has been posponed - the Caesarean Section was scheduled for 6.00 p.m. - just a couple of hours from now, but alas, the patient had gone ahead to eat a meal of Amala just 2 hours ago. You don't do a Caesarean Section on a full stomach, no way. Not unless it is an Emergency Caesarean Section in which case one is then in full alert mode for the risk of aspiration of the stomach content while under anaesthesia - a condition that can cause the patient to "drown" to death in her own vomit. I've informed Dr. Nsisi and the Anaesthetist of the need to reschedule the Caesarean Section Surgery.

Recently we had a case of left-sided Lobar Pneumonia. His relations were relieved to know it was Lobar Pnuemonia and not Tuberculosis as was suggested at some other hospital. I admitted him then, the chest X-ray confirming Lobar Pneumonia as the right diagnosis with the characteristic whitish shadows limited to the particular lung lobe affected - the left lower lobe in this case. He had been quite ill-looking, with a high fever, cough and chest pain, made worse by breathing. Lobar Pneumonia sometimes may not be that obvious, though. I hope he got the preferred antibiotics Dr Larry prescribed 5 days later upon his discharge - "funny" things happen at our pharmacy sometimes. I met him leaving still with a little chest pain. With Lobar Pneumonia it usually takes about 2 weeks for full recovery.

Today, as was yesterday, was busy at the out-patient clinic. Upper Motor Neurone Disease was my diagnosis in a middle aged man who entered with a funny, unsteady gait. Too bad, for Upper Motor Neurone Disease is often a progressive disorder of nerve tissue rendering the patient difficulty in taking control of his voluntary muscles - actions like walking, then becomes unsteady with Upper Motor Neurone disease. He had the typical hyper-reflexia - his knee jerk was so obvious - and slur to his speech seen in most Upper Motor Neurone Diseased patients, and sad as it sounds, I was not able to do much for him. ... And, the bleeding is arrested in the Gulf of Mexico!

You know when a medical emergency has arrived when the noise of several heavy, clumsy feet grow louder and louder towards you. So it was, as I sat in my consulting room three days ago, when this young man was rushed in semi-conscious. The accompanying elder sister calmly narrated how they had both eaten lunch at home before setting out on their journey to a popular open market quite close to the hospital where I work - when he began complaining of feeling ill; later leaning over on a stall just before passing-out on the ground. He was "drowsy" but rousable when I called out his name. I pondered what the diagnosis could be as the nurse gave the steroid (Hydrocortisone 200mg) shot through the i.v. line secured - no recent fever or complaints of ill-health whatsoever nor was there any history of Seizure Disorders. Then the fact came forward that he fell backward and hit his head while shooting basket ball hoops at home - but that was four days ago and he then didn't appear h...

Well, this "dad" came down to my consulting room yesterday, complaining angrily that it appeared his daughter had been neglected. Up until then I had been unaware of the case of the young lady with Bone-pain Crisis in Sicle Cell Disease - it wasn't quite half an hour that I had resumed duty and apparently the patient's intra-venous "line" had been unsuccessfully attempted earlier in the day, or so it seemed, and her parent had started to feel abandoned - which wasn't quite the case as she wasn't yet due for her next shot of i.v. injections, anyway. Eventually I went up and was able to secure the i.v. line on her right forearm. I then resumed her continuous i.v. fluid infusion - good thing that she had all the while tolerated lots of fluid by mouth. Apparently she had also ran a fever and diagnosed with possible Malaria. She appeared a little subdued in mannerisms as her dad informed me of her forth-coming school exams in three days. Later, I learnt o...

We all somewhat take life for granted - I guess that's healthy, though. We can't go around all day gloating at the greatness of our existence, otherwise what time will we have to actually live it out? So we can all be forgiven for the certain measure we do not consciously count our natural blessings every single moment. But how sad, how striking it was when we (I, assisting Dr. Nsisi) delivered, through a Caesarean section four days ago, a fully matured female baby with half of its left leg (from mid Tibia, down) missing - ending in a rounded stump. Like the "Thalidomide babies" of yesteryears! It wasn't the first limb deformity at birth that I would experience, but it certainly was the most striking. And, heart-rending, too. We still ponder what may have gone wrong.

I was mad with the father of a 10-year old whose child proved to have both his scrotal sacs empty - a case of bilateral Congenital Undescended Testes. The point is both parents had known for years the condition and were hoping against all hope that one day the testes would appear, never once thinking to seek medical advice. The poor young chap would have to visit the Paediatrics Surgeon soon. I'm just back from the labour room where I had to evacuate the womb of this married lady who began to bleed just a week after finding out she was in early pregnancy; she being childless till date - she's had a couple of miscarriages in the recent past and a scan today proved once again the same matter of a miscarriage with some products of pregnancy retained, hence the needed evacuation. She'll need to see the Gynaecologist for a thorough check, the poor woman.

Last week I admitted this elderly woman brought in by her lawyer daughter - she had been made quite weak by the repeated vomiting she presented with making me suspect, amongst other things, Acute Food Poisoning. The following day's ward-round met the elderly patient much better - she even proved to be a good talker. Unfortunately however, it became evident that she had just developed a partial, left-sided facial Nerve paralysis - Bell's Palsy. Turned out shortly that she was also moderately Diabetic. I started her on oral medications, pronto.

I removed a 16 -year old boys inflamed appendix at theatre yesterday. Dr. Larry was assistant surgeon - yes, Dr. Larry is still with us. It's really a while I've been regular at updating this medical blog of mine. Anyway, the surgery went well neverminding the fact that the nurses had failed to include retractors and tissue forceps in the surgical pack! Sometime I wonder what kind of a place is being run here! Suffice it to say Dr Larry and I improviced as best we could, I at one point having to dig into the abdominal incision with two fingers -Chinese chopsticks-like - in order to find and then deliver the Caecum on whose wall the inflamed appendix was attached. Today's out-patient clinic was uninteresting, really.