Disclaimer: All names and identifying details in this story have been changed to protect the identity of those involved.
I would find myself in the ward later that afternoon. I was on call. Exchange had not called yet. I was torn between going for a shave and presenting myself uninvited to the wards. The last time I waited for exchange to call me, I had a rough night. If the mountain won’t come to Muhammad, Muhammad must go to the mountain. I was tired from the many operations that we had performed that week. Being the junior most doctor in the department, there was no rest for me. I was covering the whole surgical and orthopedic unit. Such moments have always prompted me to ask why I was born. It was a weekend. A Sunday.
I started out by discharging patients who I deemed stable enough to go home. You don’t want to add more work to the heap of work that is the daily life of a medical intern. Jane had done her third postoperative day after a hernia repair, she is the first to go. Adequate pain killers, then home. I booked her for our surgical outpatient clinic 2 weeks later. Janet had had a head injury that did not seem to be serious. She had fallen off a motorbike at a roundabout close to the hospital. The motorcyclist, fearing her wrath, sped off without mentioning a word. To hell with the money! June was in the far corner of cube B, she had stage IV colon cancer. When we operated on her to relieve an intestinal obstruction, she said that would be her last. If she ever needed another one, we let her be.
Sister Dorina was on duty with me. Dorina is not her real name. I have never met a nurse called Dorina. She is the fat mean nurse. The nurse whose opinion closes a conversation. Mama yao. Most people complain that she is tough-headed and doesn’t take any sh*t from us doctors. I hold a different opinion about her, she is nice to me. She often tells me how her daughter who lives in the US buys her nice things when she comes home. On several occasions, she has promised me a lady from her village. I am waiting. Dorina thinks I am tough like her. I tell her I try to look tough as a means of survival. The soft ones never leave the ward. There is always work for them. “Daktari, na uone huyo bed 4, siko comfortable na yeye…” she said, looking at my face to see if I would brush off her concerns. Many have done that before. Some, at a costly price. You don’t dismiss Nurse Dorina. She is the last person patients see on their way to heaven, or hell.
Miriam was in bed. Bed 4. When you come to a hospital, you lose your identity. You cease to become a father, brother, sister, or aunt. You become a bed. She had been admitted the previous night with difficulty in breathing. There was no history of an accident or something that would make a thirty-year-old suddenly become short of breath. COVID test was negative. Miriam’s chest x-ray would break my heart. It was not your usual pneumonia or chronic lung disease; she had several loops of bowel on the left side of the chest. I looked for the stomach bubble on the x-ray, it was up there, almost getting to the neck. The diaphragm had been breached. The intestines and the chest became one, at the expense of the lungs and the heart. Tragedy! A CT scan of the abdomen confirmed the same. My afternoon took a different shift. She was for theatre. Emergency explorative laparotomy. This is a fancy way of saying opening up the abdomen, removing or repairing the damaged organ, and coming out. Si nilienda kujitafutia kazi?
In December of 2010, Miriam would find herself a victim of domestic violence. She was in an abusive marriage. They had both physical and verbal fights every so often. She had slept in the cold of the verandah on several occasions when her house was consummated in a fiery rage. One day, when he could not hold back his anger, her husband stabbed her. She left, with a knife on that part of the chest. Then life happened. She doesn’t remember well what led to the other. All she remembers is that her husband was drunk. That is the injury she remembers on that side of the chest, 11 years later. She says she is lucky to be alive. She was only 19. Nineteen and married.
The theatre was unusually busy. The surgeon on call had finished doing his ‘special cases’ that had spilled over from that week. They were orthopedic operations. Most orthopedic operations are broken bones that need implants. It is the very surgeons that sell the implants. When you sell an implant to a patient, you sell them a promise as well. The promise that you will operate on them. You become a judge in your own case. Worse still, if you get an implant and you get a complication, you will have to wait for the surgeon who did the operation. You can guess what happens when your surgeon is on leave. I am a junior doctor, so I am talking in a hushed tone. Assume you never heard this. I was not called to theatre for the procedures because I would never have approved of that theatre list.
We started our operation shortly after two o’clock. The abdomen was a familiar territory by now. My heart longed for brain operations. Because neurosurgery is the pinnacle of medicine. We did an upper midline incision and an extension to the left, a few centimeters below the nipple, a left subcostal incision. Loops of bowel pop up carelessly at the incision site as soon as we enter the abdomen. We gently follow the loops from the start to the end. The stomach is a good guide, you leave it and go to the duodenum, then the jejunum, then the ileum. The ileocecal valve marks the beginning of the large intestines. We pulled all these loops of bowel that were fighting for space with the innocent lungs. The shiny central tendon that forms the center of the diaphragm and the distant up and down tapping movement on it reminds you that the heart is close by. Do not disturb. Life in progress. Next to the rib side of the diaphragm, we find a defect, 8cm, running from front to back. The black hole of death.
With a lot of difficulties, we closed the hole with silk. Silk does not get absorbed by the human body. That would reassure us of strength. We inspected the bowel and ensured that they were not dead. A dead bowel would mean life is at stake. To our great relief, the intestines were normal. With that relief came the weight of fatigue. There was no more adrenaline to carry us through. I was hungry. My last meal was the previous night. Ugali and Mala. I was too lazy to fix a proper meal. What a wrong move that was?
Miriam rose from anesthesia at around 5pm. She coughed vigorously as her brain began to reboot. I was writing the operation notes and the post-operative plan. The early postoperative period was promising. Her mother, was outside eagerly waiting for the outcome of the operation. Her daughter had been rescued from the jaws of death and the scars of a painful past. Miriam began a new journey with new scars that remind her, not of a failed marriage but of a fragile existence. I hope life treats her kind.
6pm. I hear my phone ringing. Its Accident and Emergency.