A Warm Blanket and a Fresh Pillow

I generally don’t enjoy weekend calls. Having a Saturday or Sunday call means you are literally working for 24 hours. You definitely don’t want that when your mates are busy planning a getaway to Amboseli or ruracios. A good number of my age mates are getting married by the way.  I was doing the Saturday call that week. The plan was to use time wisely because I wanted to do a little cooking with some crazy chef on youtube on top of the clinical duties I had. So I finished my ward reviews quite early and went back to do fried rump steak with the said chef. (I discovered cooking recently and I have been really crazy about it).  

I was called by the exchange at around 11am to go to Casualty. On a bad day, the emergency department can give you a proper introduction to the profession. One day I will tell you how I ended up doing eighty straight hours in pediatrics.  My good friend Dr. Maosa always gets the worst of calls though. Nothing scares the idiot anymore. Who jokes with a guy who did a splenectomy and a cesarean section in one sitting? Tell me.

 Casualty was chaotic. In one corner, you could see a teenager writhing in pain from a sports injury. On the far end, there were two children; one was fighting for his life with severe dehydration while the other was bubbling around smiling at everyone who showed interest in him. I walked through a sea of humanity to go see the patients that belonged to the surgical department. I was rotating in surgery at that time. We had two patients. One was a young woman who was barely breathing and the other was a gentleman, handcuffed and surrounded by the police. Instinctually, I joined the team that was trying to resuscitate the young lady. She was soaked in blood. Her extremities were cold and clammy. No pulse. No heartbeat. Her pupils were fixed and dilated. No corneal reflex was elicited. The ECG was straight like an arrow. No electrical activity in the heart. She was basically dead. She must have died a painful one.  Her intestines were dangling outside, eyes half-closed. I am sure if you asked her a few days prior to the incident; she didn’t imagine that she could meet her death in such harrowing circumstances.

Our attention immediately shifted to the other gentleman who was hand-cuffed. He was a well-built man with sculpted muscles from many years of lifting weights. You could see his deltoid muscle fibers tucking in beautifully behind the biceps in front and the triceps behind. His veins were admiringly visible. You could put a whole folleys catheter in those veins! We shall call him John because John is not his real name. When he saw our resigned faces, he broke down into tears. There is nothing so terrifying as breaking bad news. Sometimes one can just see your forlorn face and break down into tears. John was breaking down. He needed no doctor’s debriefing. He had seen it himself. This lady was his wife, we later found out.

Sasa mbona nilikuua jameni?”

“Mnisamehe sikujua.”

John kept saying repeatedly. He had multiple stab wounds all over his torso that were actively bleeding. He did not seem to be bothered by the bleeding. He wept and sobbed. I put some pressure pads on his wounds and stitched them one after the other. They were so many that by the time I was done, my back was aching.

As I was leaving to write my notes, he whispered to my ears,

Daktari, nipee ata siku mbili nipone, kama boys.”

His voice trembled with melancholy. At the mention of the word ‘boys’, I knew John was activating the ‘bro code’. The worst had already happened. At our discretion, we decided to admit him for a few days and booked him a psych consult. There was just so much in his mind. The wounds were not too deep to warrant an admission but his mind had just fallen apart. Reality had deserted him.  A fresh pillow and a warm blanket are all he longed for.

One Good Turn Deserves Another

I was so excited that particularly Tuesday morning. I was going to scrub in with my favorite consultant in obstetrics and gynecology. She was my favorite because of her friendly nature. She made being a consultant look so cool. Forget about those other old school-fellows who bark, bellow and blame the intern for literally everything that is going on in the patient, including a fly that just landed in the ward. Folks I haven’t intimated to you how medicine is a deeply hierarchical profession. You might convince yourself that you are working hard to save a patient’s life but in the real sense, you are working your ass off to please your mean consultant. One day I will write about vehemence in medicine. I will write about my most difficult moments in the hands of my fellow human beings.

We were doing a secondary closure of a wound that had been infected after a prior cesarean section. It was going to be my first time doing an obs/gyn procedure outside cesarean sections and salpingectomies. Salpingectomy is literally cutting out the fallopian tube. It is usually performed as a way of birth control or in cases of ruptured ectopic pregnancies.

I had got to the ward early and made sure the patient was ready. My best friend was doing a procedure on the other side of the theatre. We love working together and this was one of those opportunities. The consultant remained unscrubbed to oversee whatever we were doing. I had asked one of the beautiful medical students to be my assistant. Dear readers, the operation field is a deeply intimate space. Sometimes you can literally hear every beat of your assistant’s heart. I was going to open my heart over those forty or so minutes that I was going to be there. I chose my assistant. I see my seniors doing that all the time.

The wound we were going to repair was very clean. It was actually begging to be closed. We cleaned the patient and draped as per standard operating procedures. The wound was quite deep, almost getting to the peritoneum, the cover of the intestine, and other abdominal organs.  I asked for the scalpel. That moment was humbling. I was actually asking for a scalpel. It was surreal.  I was a little slow because it was my first time doing such an operation. We refreshed the edges of the wound till they started oozing scarlet red blood. My hand was steady and sterile. By this time, I had started a small talk to break the silence between me and the medical student assisting. She was breathing hard and smelling nice. She participated actively in my small talk as well as the operation at hand.

I got to the base of the wound in no time. That is when the plot thickened. Our conversation was getting deeper and deeper but the operation was going south. My scalpel had gone a few millimeters deep and a sudden gush of fluid-filled the operating field. My heart skipped a beat and adrenaline set in. I knew I was in trouble. The fluid was straw-colored; I had nicked the bladder.  Luckily for me, my consultant was watching every step of the way.

“Doc, don’t panic, take the size 3-0 needle and let’s repair the bladder and remember to keep the catheter for at least  14 days” She quipped.

I got confident. I slowly followed her instructions and beautifully repaired the bladder. I was terrified. In my entire rotation, I had never had such a complication. We finally managed to close the wound. The conversation stopped suddenly. We could not get back to where we were, we just wanted to get done with the operation and grab some food. The opportunity had gone. Taken away by an injured bladder. I longed for another operation, I longed for another moment with that particular medical student that was breathing hard and smelling nice. Why was she breathing hard though?

Bikini Line Incision

I loved my obstetrics and gynecology rotation. It was a bloody business that rotation. I loved it mostly because it was ladened with human drama.

Pregnancy, as I have come to learn, is always a ticking time bomb. A seemingly normal pregnancy can take twists and turns in matter of minutes. It is worse if that pregnancy is outside the uterus. This is the mother of all chaos.

So on that fateful day I was called by my senior to go operate on a woman with a ruptured ectopic pregnancy to help build my surgical skills. I thrive on adrenaline folks, so I cherish the moments when am the one holding the scalpel. The lady in question was about twenty six; she was beautiful with a nice tiny smile despite the pain she was experiencing. She was pale with very low blood pressure. Time was of the essence. The sword of Damocles was hanging around our necks.

I made an incision just at the bikini line, the standard incision for a caesarean section. There was not so much fat so opening the abdomen was not very difficult. We got to the rectus sheath, tore it open and within no time we were in the peritoneum. I remembered the words of Professor Jani, “Respect the peritoneum and it will respect you.” Those words never leave me whenever I am operating. Since we were not going into the bowels, I was not very worried about contamination.

The peritoneum was full of clotted blood. This was scary to me because I hadn’t done many of such operations. We removed the clot and quickly went to the fallopian tube to deal with the culprit. The right fallopian tube was ruptured and was actively bleeding. We arrested the bleeding to my relief. That was the moment I realized that I was drowning in my own sweat. It had been one hell of an operation. We saved the lady and it was beautiful. The left fallopian tube was visualized and it was normal.

So a few days later, the lady was so depressed that she was wanted to die.

‘Daktari, ata mngeacha tu nikufe,’ she said staring blankly at the wall.

‘Mbona?’ I asked a little surprised.

It was at this moment that she got so vulnerable and shared her story. She had been pregnant for another man while the husband was away. She had initially wanted to abort the fetus but now the ectopic was embarrassing and threatening to kill her. The husband had been called and was on his way. I knew he was going to ask me details about his wife’s condition. Folks, how do you tell a man that his wife got an ectopic pregnancy with another man?

Stainless Steel

The night started out calm. We had just finished a case of surgical toileting that didn’t last an hour. I got excited because I was finally going to be able to catch some sleep. I asked the surgical resident to let me do the next operation before we call it a night. At this point, if you told me that that night was going to be my longest, I would never have believed you.

I went to the ward and prepared the patient. He was a man in his forties. A lovely human being, to say the least. He had a genuine laughter with a deafening crescendo in the early phases, brief plateau phase and a sudden stop. He had smoked loads and loads of cigarettes. His hands and lips were pitch dark from the many years of smoking. We were going to cut his leg that had since become so painful after losing its blood supply. It was going to be my first amputation. I was anxious.

The operation started shortly after 11 pm. We projected that we would be done by midnight. My hands were steady and sterile. After years of hard work I was finally having this moment. My mother would have been proud of me had she got an opportunity to get into our theatre that night. I am my mother’s son. I took my space and spoke gently as we were doing the WHO timeout before the operation.

“Any critical or non-routine steps? “ the circulating nurse asked in a lovely voice


“Anticipated blood loss?”

“500 mls”

I made a fish mouth incision on the thigh and dissected out the powerful quadriceps, tying the major bleeders and coagulating the smaller ones.  The noise from the monitors and the sound of diathermy in action was occasionally interrupted by a few stories among the nurses. Sooner or later, we got to the femoral artery and vein and their large branches. We dissected and tied them.

A few minutes later, we got to the femur. I held the saw and started cutting the bone. All of a sudden our theatre became a work shop. I often wondered how someone would choose this carpentry specialty of medicine.  Orthopedics would never give me joy for sure. The bone was becoming unusually hard. The saw was getting blunt in the process. The patient was under spinal anesthesia, so he was able to talk.

He said, “Daktari hiyo mguu niliwekewa chuma  2010.”

I almost collapsed. All this while I had been struggling to cut a bone that had been reinforced with stainless steel. Worst of all, no one in the entire team had picked up that history of previous surgery. That is the moment I knew we were on the brink of tragedy.  It was 1 am. The ambient temperature was well below 10 degrees Celsius. I was freezing. We threw in the towel and decided to ask for senior help. The consultant on call that night did not pick up his phone. My heart was racing. We called another one who managed to pick up and come to our rescue. We sat still and waited. The great wait of my life. The operation had prolonged so the risk of complications was rising with every minute of further delay.

We expected that he would shout at us. He did not. He scrubbed up quickly and joined our mess. The implant was removed to our great relief. We finished up the operation a few minutes past four. That night was not easy folks. Luckily for the patient, he never complicated. We discharged him on the third post-operative day.

Post Exposure Prophylaxis

The Doctor On Call

I wanted to hate that guy. I would have loved to hate that guy. How do you just bump into a consultation room without being called? You know it is unethical, it is lack of courtesy. He looked like the one who knew little about etiquette. I later realized that he was called Omondi (not his real name), Omondi from Homabay. Had he arrived a minute or so earlier, he would have found us examining the breast of a fairly young lady that came in with a lump in the right breast and was very worried. Luckily for her, we had finished the examination and she was dressing up.

Omondi  waited patiently outside till we finished with the lady. Then he got in without waiting for his name to be called. Did we throw courtesy to the jackals? Fortunately, he was next in line. He was a well built man…

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