A Doctor's "Secret" Health Notes

July 30th I discharged the Herniorraphy/Hydrocelectomy patient today. He still walked funny, his scrotal sac still baggy from the over-stretch, off and on, of over twenty years. Like a pregnant woman's abdomen that shrinks to normal size after delivery, so will his big scrotum. The man grinned when I informed him so. I smiled back within me. The Hysterical patient admitted few days back and who "convulsed", has remained sedated ever since and calm when she arouses a bit. I began tailing off her medication today. We shall see how she fairs by tomorrow. July 3oth A patient, let's call her Mrs B, who I admitted about a week ago with a nagging lower abdominal pain, is quite better today. After 3 previous Casarean Sections and an Appendectomy, my working diagnosis as I admitted her was Post-operative Intra-abdominal Adhesions. Occassionally, long after extensive intra-abdominal surgery, the intra-abdominal organs may get loosely attached by cobweb-like fibrous strands or e

July 28th Monday morning ward-rounds were mine to conduct. I went about them with some of the nursing staff. I observed that certain notable patients such as the 12 year old with the Enteritis, had over the weekend been discharged and replaced by new cases. Our Hernia/Hydrocele case seemed to be fairly recovering post-operatively, today being the 6th day. I later settled down at the out-patients clinic. I admitted this woman who acted demented, not saying a word to me as I tried to engage her. This was after she walked into my consulting room all by herself. She was brought to hospital by a colleague of hers who would later act as the informant, and later joined by the patient's older and younger siblings who had been called. At one point during the information gathering, she became slightly aggitated and confused-looking, never uttering a word. A widow of 2 years who lives with her kids, the oldest being 13 years, she had exhibited a mild trait of delusion for which she had been s

July 25th Woke up in a rush this morning. I was running late and It isn't decent keeping patients waiting at the out-patients clinic. There was no one waiting as I walked the short corridor to my consulting room. Soon enough they began to arrive. A young lady had a bad finger-nail and this had been so for about a year now. Very soon, I took the lady's hand and wedged a scissor blade deeply into the nail-bed of the affected finger. I was a little suprised that the lady was able to watch calmly as the scissor blade played around, wedged in-between finger-nail and nail-bed. Of course she felt no pain whatsoever, but still I thought her incapable of baring the sight, as would most patients. A local anaesthetic that I had injected around the base of the finger had deadened it to all pain. "Thank you" she said when I was finally done, and then left. July 25th Dr Akindele and I observed a lady's cervix through a speculum inserted into her vagina for that very purpose.

July 22nd Dr Nsisi performed a Herniorrhaphy this night and I assisted. A Herniorrhaphy is the surgery done to repair a Hernia, of which the commonest is the Inguino-scrotal Hernia. This is the type that we performed. The man has been living with it for over twenty years, it being at the Reducible stage. In other words it would collapse back spontaneously, off and on, or the patient would push it back himself. So we say then that it is a Reducible Hernia. I talk about a Hernia collapsing back. This is possible when you understand that a Hernia is an abnormal protrusion of organs (usually a part of the intestine) outwards, through a weak point on the wall surrounding the cavity within which the organ is found. The abdominal cavity and the abdominal wall, in this case. I'll give a clear and common example. Children with big navels. It is a part of the intestine that pushes out through a "hole" found just above the navel area. So we call it a Para-umbilical Hernia. Umbilicus

July 21st The infertile couple returned with the story that the rash came back the next day following the consultation. It had vanished shortly after the Hydrocortisone injection had been given, only for it to begin to creep back that same evening, finally becoming worse than before over the week-end. I asked about usage of the steroid tablets prescribed to which she affirmed a correct usage. I was shocked to discover next that she had rubbed a concoction of local herbs cooked in palm oil well unto her skin. This she had done the day after their consultation with me. No wonder then that the rash had become redder and angry-looking. She had caused matters to go worse by her own hands. I let her know I was slightly irritated by this development. In response, her husband showed slight impatience towards me, and he an educated man. I calmly wrote the same prescription and some more. I added antibiotics, ordinarily not found in prescriptions for Urticaria. She was now getting feverish, af

July 18th I had a middle-aged male yesterday, referred from his company clinic. His problem was difficulty in micturating. He would get to a convenience whenever he feels the urge to pass urine but then finds that he needs to wait for many seconds to lapse before the urine out-flow can actually begin. There usually is some straining on his part to achieve a good stream. Obviously he has some degree of obstruction anywhere along the urinary out-let. Could be a Urethral Stricture or a disease pathology of the Prostate gland. I had to do a full physical examination of the abdomen. This included a "digital" examination. This is a physical assessment per rectum (or a PR), in which the right index finger of the gloved hand, is inserted deeply into the rectum via the anus, in a certain deft maneouvre. I went ahead, informed and prepared him on my couch and then executed this maneouvre, thus acertaining the nature of the rectal mucosa as well as the prostate gland, all in one sweep

July 18th My boss is out of town. That leaves the boss's wife (Dr Mrs.), Dr Nsisi, Dr Akindele, Dr Larry, Dr Ojelade (The Dentist) and I, to run the hospital. That's not counting the Nursing staff, the Optometrist, the Labroratory Technologists, the Radiographer and all other cadre that run the other hospital departments, day in day out. Ours is in fact a Medical Centre, somewhere in the heart of Lagos in Nigeria. And today, we had a run of out-patients as is usually the case. A noteworthy case was that of a lady, accompanied by her husband, who entered my consulting room looking aggitated. The reason for her discomfort was soon evident - Urticarial rashes all over her body. These are very itchy weals that appear on the skin surface in their characteristic manner, caused by an allergic reaction within the body. The allergen was soon deciphered upon further inquiry - She had used a branded toilet soap, popular for its skin-fading action, hours before the allergic reaction starte

May 23rd - July 17 th Hello, folks. You may have noticed hitherto, entries in this medical blog that lagged behind by two months or so. Well, those were my entries made before I pitched my tent here at Google's blogger and they in fact constitute all of the documented accounts of my day-to-day routine at work that I have so far penned down any where. Events encountered at work between May 23rd and July 17 th , were not put down on record unfortunately. I spent that period working as usual, organizing personal matters and then eventually re-launching my medical diary here on blogger. Tomorrow, I shall commence entries in this blog that would reflect my updated schedule of events at work, current within a 48 hour period lag. Today July 17 th , by the way, was the usual out-patient drill.

May 22nd You make an incision first on the skin, and then further incisions on each subsequent layer until the final one is made on the uterus (womb). Quickly the baby is extracted and the fast-bleeding edges of the uterus is clamped, here and there. You hear the new-born crying its head off as you deftly suture the gash on the womb, reassured now that the baby and mother should be quite safe. . . Such was the scenerio 3 hours ago, as I performed yet another Emergency Caesarean Section with Dr Larry assisting. The indication being foeto-maternal distress in a Prolonged, Obstructed labour. Only down-side was, Dr Larry and I not getting to see the UEFA Champions league final match-up between Chelsea FC and Manchester United - Just a little joke.

May 9th We lost the patient with advanced Tetanus. She died yesterday; so sad. Tetanus. Quite a deadly disease when treatment is delayed and the disease is at the advanced stage. The causative organism is a bacterium, Clostridium Tetani, that abounds in the soil and found in rusted iron. Apparently, the poor woman had had a locally done pedicure to her foot that resulted later into an infected wound. This would be the obvious source of entry into her system, of the deadly bacterium. Today also, we sadly lost a baby just before birth, and during labour. The cause of death can only be speculated here at best and its determination is subject to the degree to which intra-partum foetal monitoring and management is carried out at our centre. So, to what degree is intra-partum foetal monitoring and management carried out in this hospital where I work, you may well ask. I would say without elaborating in detail, that the standards could much be improved upon. We averted another possible intra-

May 6th A female patient with Tetanus is on admission in the female ward. She is already having frequent, muscular spasms. Very deadly at this stage of the disease, I might add. Our Staff Nurse/Mid-wife who had a difficult first-time delivery last week, I circumcised her baby boy today. She was one very happy nurse, let me tell you.

May 2nd Today on the Campaign trail . . . Oops! Don't mind me. It is not as if I follow Barack Obama every where he goes campaigning. I follow his campaign on the web most nights, though. I like the guy. Today on my Out-patient clinic consultations . . . Patients take turns coming in. They sit down then I begin to decipher what manner of ailment they have, quite often a daunting task for lack of adequate communication skills on their part. Eventually they leave when they are done with me only for the next patient to resume the challenge. I wish sometimes that I were on any presidential campaign trail, for want of a little excitement on the job.

May 1st Didn't go to work today. Sorry, I ought to have said "yesterday". It's gone past mid-night already. April 30th Me, big-hearted? I'd rather believe I was only doing my job, Shamsa, in empathising with the patient's plight. I assume we both are refering to the H.I.V. patient who eventually got the job. Our labroratory had confirmed same status. This was then conveyed by the hospital to the company, after the young lady and I had decided she would rest all hope upon the outcome of her meeting with a certain member of the company's PR team whom she had earlier on planned to see, thus relying entirely on his sense of fairness. Her hopes had not been dashed, so she had informed me via SMS, days after. I was glad for her. Today, I have circumcisions aplenty. . . And, 3 lollipops popped! April 29th As I walked away from the Staff nurse I had gone to fetch in the female ward for yet another Caesarean Section, a pretty but sullen-faced patient on the far bed

April 26th Finally, our usually dutiful Staff Nurse, had a safe delivery of her own. It sure was a difficult delivery, with a resultant perineal tear that was promptly repaired. A baby boy weighing 3.3 kg. Many times it is not so much of the baby's weight or head size that results in the difficulty but rather, the manner in which the head presents in relation to the bony pelvic out-let. A Brow presentation, for example, offers a larger diameter, and so on. Actually I'm off-duty today. I'm told by my colleague that another potentially difficult delivery is currently "incubating" in the labour room. By the way, I live within the hospital confines.

April 25th Assisted Dr Nsisi in the Theatre today. I haven't seen an inflamed appendix that huge and ready to rupture in a long while. Surgery was a success, thank goodness. One of our very own; a Staff Nurse/Midwife, is in labour even as I type this entry. She is nuliparous, and so, her first time in labour. She had a lucky break ealier at 8 months gestation when the baby turned, changing its position from the breech posture, to the cephalic one. She very likely would have required surgery otherwise. Now in labour, she appears edgy. It's proving to be a difficult one; painfully slow in its progress. April 24th The female with the macerated twin who was delivered through Caesarean Section 3 weeks ago, was rushed in today as an emergency, bleeding severely, per vaginam . Diagnosis was Pueperal, Post-operative Sepsis. It appeared that the powerful antibiotic cover she ought to have received post-operatively, were inadequately administered . . . She unavoidably was t

April 19th Ordinary day at the out-patient consulting clinic. Concerning that Reverend gentleman who had his neck tumour removed. Well, the wound is nearly closed and oozing less fluid, ever since we began daily dressing from the time his stitches were removed. Not too suprising though, considering the Tuberculous nature of this surgical wound, at origin. April 18th Wet lollipops is how they look like, when infant penises are newly circumcised. Forgot to mention I did two circumcisions the other day. I use this metal device and this method gives instant results. They finally peep out looking like kiddies lollies. You should be able to tell by now that I'm a general-duty doctor in this private hospital setting that I'm employed at. I see all manner of cases, only to then refer to our specialists when occassioned. Today's activities? Ordinary day consulting at the out-patients. April 17th Today too, was ordinary. I went to the bank at close of day. I watched the bespectacled

April 16th Removed a lump from a female's neck today. Likely of fat origin - A Lipoma. Oh, yes. Good news. Remember the other neck swelling? Well, the histology report makes it out to be - I'll spare you the jargon - a Tuberculous neck tumour. Now, that's much more favourable than a Cancer, obviously. He'll live. By the way, the gentleman is a Reverend, though I suspect it's one of those "ceremonial" types. April 15th Boring day managing out-patients . . . The stitches came out today and the pretty patient discharged. I refer to the Appendectomy case I did 7 days ago. Truth be told, same way I confessed to Dr Larry, that I quite admire the young lady. That is to say, from a certain anatomically provocative perspective. It goes no further however, for I am sworn to an oath as you well may know. Two oaths in fact, in that same regard, for I am married. April 13th I'm still weekending and off-duty. Read all about Al Capone on the web, wow! Real -life dram

April 12th Off-duty this week-end. Time to catch-up on other things.. April 11th Saw a few out-patients then left for Ikoyi to attend to some personal matters. April 9th Caesarean Section today went well. Mother and baby-boy are fine. Remind me to introduce my boss, the Medical Director, to these secret documentations. He quite simply is an interesting individual; a Consultant Neurologist at that.

April 9th Appendectomy performed successfully on my young patient, this p.m. No other noteworthy occurrence today. Booked-down a Caesarean Section - I shall be assisting Dr Nsisi tomorrow on this one. O.k, a confession. I was solicited for an unwarranted sick-leave paper by this pretty female patient of mine; a Banker. Not the least bit ill, she only needed the time-off to travel out of the country for a brief, personal business dealing. I obliged! April 8th A surgical incision through 7 layers of anterior abdominal wall, is what I shall be making on this young female patient tomorrow at Theatre,who suffers Acute Appendicitis. This would bring me into her abdominal cavity, where upon I shall begin the manoeuvre of removing her infected, troubling Appendix.

April 7th It was confirmed at Theatre two weeks ago that the second twin of this unfortunate mother was macerated. Our first incline came an hour earlier when it was noticed, a life-less little hand gone all blue and cold, protruding out of the mother's vagina. The other twin was alive. The poor mum had been on admission about a week or so prior to the incident, as a case of Twin pregnancy at 8 months gestation in a once previous Caesarean Section, and with one twin persistently in Transverse lie. Post-operatively, both mother and surviving twin have continued to stay in good health. April 6th Women have achieved normal delivery more readily, so I have observed on record, when labour is allowed to progress unaided for as long a time as possible. Such is the case when at advanced labour, say 8 - 9cm cervical dilatation, a patient arrives at the hospital haven laboured at home for quite a while, and will soon be delivered of her baby with relatively more ease. The baby then seems to

April 4th This 4 year-old boy was brought in as an emergency having been pelted inside a moving vehicle driven by the mum. He was quite shaken-up but rather stable. His mum was a little apprehensive but mostly quiet. The boy however, had a bruising with tenderness around the left shoulder that was confirmed through X-rays to be a Fracture of the left collar bone. Well, I applied a figure-of-eight bandage around those little shoulders. It's noteworthy here that this accident could have been prevented by the usage of a child-restraining device. Bad mum, I must say. April 4th He may well survive afterall, this gentleman whose right-sided neck tumour we removed surgically 10 days back and who had his stitches out today. Was it a Tuberculous growth or a Cancer? The histology report of tissue samples taken and sent, will determine its exact nature. The report is expected anytime soon. I discharged the patient with the left scrotal swelling today. There was a hitherto