of life as A DOCTOR

So, am a registrar, am pursuing my postgraduate degree in Obstetrics and Gynecology. I am doing what I love, it is my passion it is my life, sounds very glamorous right? hold that thought, right there.....

I went through medical school, it was crazy, has always been and it will forever be, it was tough, it was rewarding, I gained so much knowledge in such a short time and had good days, horrible days and at times....plain boring ones too. What gave me nightmares most days was the days we would have Major ward rounds though....the Consultants would dress you down, insult you, ask you the only question you hadn't read about, scare you shitless about how you would never pass exams with the kind of knowledge you had bla bla bla and the spirits would be crashed.....but never completely because we all still lifted our heads, went back to the library, read some more and even attempted several more Ward rounds until we eventually did exams and moved on to the next level. At one time I had sworn I would never go back to school, I would never want to be that registrar who's given that thorough dress down and in front of the over eager and overzealous undergrads!

Yet, as fate would have it, I did eventually go back to school. Am back to the grind, the Ward rounds, The dress downs the harassment, the work that never ends. Residency is tough all over the world, most people go for even 72 hours whilst on their feet....I guess this is supposed to toughen me up? But could I just ask for what I want? Please................

I am a Masters STUDENT. I am pursuing a Masters degree to be a Specialist. I am HUNGRY for knowledge. I am at This Prestigious University to LEARN, TO SPECIALISE to be THE BEST. I am very passionate about this, this is life from here going forwards, as MJ said it, this is it! SO when am in school, and work,( somehow the two have become interchangeable).....I want to see my patients, I want to give them the best care, I want to spend time with my pregnant client, I want to answer her 1001 questions. I want to reassure her, I want to be so thorough so as not to miss the subtlest of signs!this I can't humanly do, if ever day am in the clinic, I get forty files! By the time am seeing number40, seriously I shall not be making any useful decisions. I mean...How??

I am surgeon. Obstetrics & Gynecology ( Fellow doctors, substitute this with anything else you're doing, Radiology/ Surgery/ Neuro/ Ophthalmology etc)  is the most glamorous profession! I want to do my Colposcopy competently, I want to repair VVFs, I want to do pelvic floor surgery...I want to be a guru at Wertheim's Hysterectomy, I want to do my Cesarean sections like The prof who's posted these outrageously interesting surgeries on YouTube. I want to work with a team of brilliant professionals fro all the other fields. I want Excellent pathology Report, I want Precise and Concise radiography, I want Neonatologists who are world class by my side... I want Glamorous Doctors by my side.

I am a mother and a wife.A friend to many. I want a glamorous life. I want to feel like all the years I put in Med school...somehow paid off, that when I save that life, someone somewhere appreciated it, that when I see a baby I delivered so many years ago, has gone on to become a serious person in society. I want my Family to enjoy being under the wings of this "glamorous medical field". Yes I want to drive that good car, I want to afford medical care, the same medical care that am able to offer to my patients. I want to rest in my own house, take a holiday, enjoy a drink.....take in life, one sip at a time.

Pastor M, I have tried to be positive Day 5 and going strong. But you my dear patients, also appreciate your doctors, affirm us, pray for us. WE are the doctors, more often than not, we know what we are doing. Trust us, stand by us, support us. If you think one doctor said something you don't quite agree, seek a second opinion and a third and a fourth. It is your right.....and PRAY for us.

Next time you go to hospital, and find this dishevelled looking chap, with shaggy hair, scraggly beard, upturned un ironed shirt, and this trouser that is falling just short of some shoes that last saw a shoe brush ages ago...(You probably wouldn't allow your farm hand to even wear such in the farm) .Jut know this...He is probably just come from a night shift in a certain hospital, He had to go to school( read official work)to do a quick ward round before he rushed to this prestigious hospital to attend to you. He probably has a wife and child at home, who haven't seen him in the last 24 hours.He has no stable income, he needs to do this run around to Pay his Rent, Pay school Fees, Maintain his house, PAY SCHOOL FEES FOR HIMSELF and still send his parents Money because they expect it...I mean, which parent do you know who's not always bragging about having a child who's a doctor? She could be a mother, with a child and she needs to give this child the same opportunities she had when growing up, but with the measly pay or no pay at all....she hardly even has the time to breast feed let alone spend ample time with her child. Do I wonder now why those consultants were so mean to us? No! Life was tough and why shouldn't they pass on their frustrations to this disheveled looking extremely dejected young specialist?

That doctor could be THE doctor, who spent so much time saving lives, yet when it came to saving his own life from Severe Malaria, He couldn't afford Medical care and died. It could be that doctor who was working in such a poorly equipped hospital that a gas explosion occurred as she was working on her patient and ended up in ICU in a private Hospital, and because she couldn't afford the Unit, had to be transferred to a Govt Hospital and died. It could be that doc who couldn't afford specialised treatment abroad and died.....

COMRADES, enough said.

OF LIFE, PRECIOUS LIFE

So, I have this passion for teenagers, I love the way they are just so passionate, versatile, crazy, averse to authority but what I admire most in them is their minds, if molded and guided well, they inevitably become very well grounded adults who can make such a great impact our society. And that is one of my passions, to mentor and provide guidance to this very critical age.

so it was in this frame of mind that I attended to this young lady in the wards. Nineteen year old admitted in labour. She progressed and delivered a healthy baby and I was now seeing her on the second day post delivery. I go through her documentation and see that throughout her pregnancy everything was fine. No complications everything went like clockwork for this young lady. I examine her and she looked a little distressed, she was facing away from the child and complained the way she had not slept well through the night thanks to a newborn. ( Understandably, shes a teen mother and a baby is a big responsibility and she would have to make major changes in her life to accommodate the newcomer). So I chat with her a bit, do the general examination and even tell her am considering discharging her home. Young girl gets excited and tells me, she has in fact missed her bed at home and some home cooked food...I mean, who like Hospital food anyway.....

As I am getting ready to take her vital signs, the young lady literally convulses on me! as in, we are talking, next minute she is semi conscious in bed! What? I call for help and we do the baseline assessments, Blood sugar is normal, she has no fever, heart rate is acceptable, and the MONSTER? Her Blood Pressure is rocket high!! What? We rush her to the emergency unit since she will require critical care and treatment is commenced, her consciousness level is still reduced and unfortunately she convulses two or three more times, intractable convulsions. ICU is called in and my teen mother is admitted for intubation and ventilatory support.

So what happened? This young lady suffered from post partum eclampsia which means a condition where a patient after delivery suffers from high blood pressure which is directly related to pregnancy or in this case the after effects of it and leading to brain swelling and thus a convulsion. Eclampsia is every obstetrician's nightmare because it causes a myriad of complications on the pregnant woman. it commonly occurs in TEENAGERS, young mothers, especially in first time pregnancies amongst other predisposing factors. Its first major deleterious effect is on the baby if it happens before delivery. The fetus ends up with growth retardation or at worst fetal demise. On the young mothers, the condition damages the brain, lungs, kidneys and liver.

So the young lady was in ICU for a week, THE DREADED ECLAMPSIA had caused so much brain edema she was declared brain dead and she succumbed, life nipped in the bud, even before it had began. A very sad day for me. She had left behind a child who had not even began enjoying what it feels to have a mother, the child will never know his mother. It got me thinking, how many teens out there engage in risky behaviour, not knowing the consequences of their action? Further still, how many of us, take time to appreciate life? We take a lot for granted not knowing that yes, life is fickle, it could flicker off on us any time...

RIP my dear, and for the little child you left behind, may God watch over him.

OF LEAKING......

So today I was all up in arms in women’s nether lands…..doing what I do best. But today was different, we were  repairing the ravages that child bearing has on mothers, those who deliver at home, with no skilled attendants or those who actually have no access to medical personnel, the rest, those who entrust the beautiful job of child birth to untrained traditional birth attendants.

It all started yesterday, I admitted a lady with a recto vaginal fistula. What this means in simple terms is that her rectum, what transmits stool to outside the body is in communication with the vagina, meaning there is a hole and thus instead of faeces passing through the rectum and out through the anus, it instead leaks through into the vagina and thus the lady always had stool leaking. This usually happens due to prolonged and obstructed labor or in cases where a woman delivers at home by herself or with unskilled help and the baby’s head tears away at the mother’s “Nether lands” wrecking all that havoc.

In her case, 8 years ago she had a delivery at home. Unattended. Her husband was away and she was living upcountry. Soon after that, she noticed she was no longer able to hold her stool and she had leakage. She had had three other children prior to this, and all were home deliveries, I mean am sure she wondered why this last one would be any different. Am sure you’re wondering why it took her eight years to seek help…..I was curious too.

She told me; first and foremost she was ashamed about it. That I understand. But what came next broke my heart into very many tiny pieces…. Her husband abandoned her because of her condition….well, let me explain it. During sexual intercourse with her, sometimes he would go into the “wrong” canal….because she had sustained a very severe tear, the vagina and the rectum were almost one and the same thing and when her husband went into the wrong canal, she was in excruciating pain. To add insult to injury, you can imagine she ended up soiling herself, her inner garments, the bed… (I mean ladies we all know how clean and private our private biz is always kept). Secondly, she would not even associate with people because if she left the confines of her house, she would end up with a “stool accident” and you can imagine how she would be shunned if she happened to be in a matatu for example.

I looked at this lady, beaten and bruised by shame for eight long years. She had not a shred of dignity, let alone self esteem with her…she could not even pretend to smile, it wasn’t anywhere in her vocabulary, I can imagine her husband could possibly have abused her physically, mentally or emotionally for being a “dirty” woman…..well by just leaving her, spoke volumes and volumes. I can imagine how she lives with her kids, do they sometimes in their innocence ask why she reeks of stool? Her neighbors? Her relatives? Her fellow women? Until she heard the little announcement on radio, about leakage of urine and faeces following childbirth and where to seek help.

We sorted out the bad bad tear, the operation was like an hour long, by the time we were done, her perineum looked as good as new, better than an untouched girl….I saw a little smile on the corner of her mouth……..a fleeting smile like she couldn’t just believe that it was all over, that she could get her life back, a smile back, a dry vagina, a normal life….even get to enjoy sex once again.

If you know anyone with such a problem, in Nairobi, send them to VVF clinic, KNH, around Kenya, to any AMREF unit and around the world; hope the issue is not as burdensome as Africa. And to the selfless Doctors like Dr. W.K may God continuously bless you, in your footsteps I look forward to follow.

of THE SCOURGE....CANCER!

So, it has been a while..... but I was in elective Gynecology theatre last week. It is those dreaded four hour long cases that leave one tired like hell. This lady is wheeled in, she was diagnosed with Ovarian Cancer, she had received 4 courses of chemotherapy to sort of shrink the tumor in preparation for complete excision.To cap it all, she had retroviral disease. so we go in, open the abdomen and walala!!! The seemingly docile ovarian tumor had reared its very ugly head all over our patient's abdomen! you know how cauliflower looks? Now imagine pieces of that cauliflower all over the intestines, the liver, the abdominal wall on the insides and a huge ugly bigger mass resting on her ovary and the uterus! The situation was grim........

At this point I asked myself.......the surgery we were to do is called debulking....we remove as much tumor as we can so that as we then continue with chemo, it has a higher chance of being effective. in this instance, the monstrous cancer had reared it ugly head all up in this abdomen, even if we removed the primary one, would it be enough to cure the "rest of the many cauliflower pieces in the abdomen"? Furthermore, this lady had retroviral disease to add icing to this cake, if the cancer didn't get her, the chemotherapy combined with her status was surely going to win!

Needless to say, we were on our feet for more than five hours, the uterus and affected ovary were removed......(this was so tedious and painstakingly difficult) but it was done, then upon recovery, we embark on chemotherapy.... Sometimes I wonder, is it worth wile to do all these? do we add life into these cancer patients...a long, painful, bedridden life with our "heroic"measures? sometimes, why don't we just let them have more peace into the short time left? The mighty have fallen from it, am sure they had the best care in the world.....R.I.P Prof Wangari Maathai the next Nobel, may it be about a cure for the scourge,, R.I.P Steve Jobs.... the next APP, quick detections???

This piece I dedicate to my friend, she is so keen on being a cancer specialist, I pray one day, you will give us solutions.....<SIGH>

OF BLOCKED TUBES...

So today am in the usual, very jam packed clinic working my school fees away, when this lady walks in. Young lady not more than thirty years of age. She has been on follow up in our institution for the last year or so on issues of infertility.

On her last visit, she had been admitted with a diagnosis of primary infertility for tuboplasty (an operation done to open up the blocked tubes). Unfortunately, when the doctor went 'in' the situation was grim, the blockage was too close to the uterus, an area that is almost impossible to venture into due to the thickness of the tube, the menacing blood vessels that lie beneath there waiting to be poked and give the doctors grief plus success rates on this area are very poor. So the operation had ended as an open and literally shut case! With advise to the woman to seek '''other options''.

So today she comes in, she has done a repeat HSG (an xray that is done to delineate the uterus and tubes) just in case the surgery worked......HOPE for a desperate soul. Unfortunately for her, I had no hope to offer her, tubes are still as blocked as ever. I told her, she has other options, IVF(donation and implantation of an embryo into her uterus), here the procedure costs an arm and a leg, and remember it usually requires repeat implants due to pregnancy losses associated with it. Her, she is a housewife(not the celebrated real housewives of Atlanta or New Jersey...Who has watched that reality show???whaaat???) and her husband is a driver....need I say more?

Option number two-adoption. Africans have something negative about it....(Why? there are too many motherless and fatherless children out there, looking for someone to love them back!) She was downcast, sad, forlorn, desperate, very very heartbroken. I can only imagine what she will have to tell her husband when she gets home in the evening....

I felt tears well in my eyes, and today I pray for every woman out there in the pursuit of a child........the long, dark,rugged and sometimes very disappointing road!

OF PAP SMEARS

So last week on Friday I was in theatre doing Examination of women with cervical cancer under anaesthesia.For those who are in the profession you know that this is not an exciting thing at all. I went in ready to tackle the five women who were waiting for my examination. So along came the first lady, an elderly cucu and she had pretty advanced disease and the tumor just reared its ugly head at me as soon as I put in my tools of trade.....sad! Next was a middle aged lady, she had advanced disease but this time her tumor was ingrown......a rugged, nasty, gross aggressive thing....horrible! Next was a thirty something( I Say this with a pinch of salt seeing as I had a birthday recently....Twentieth!) and I remember praying and asking God to please let this be a better story. But alas, as soon as I put in the speculum, the menacing tumour glared at me and bled with so much gusto like it was leering at me and saying...."I got here first doc! Ha! In your FACE!". The next was a forty something and lets just say-HORRID!

Cervical cancer is caused by a virus simply known as HPV. It is on the increase and we are now seeing very young ladies suffering from it. Once it attacks, it is so vicious and in advanced cases, the ending is sadly.....just that, sad! In our out patient clinic we get to see so many terminal patients who have nowhere else to go and being a referral unit and not a Hospice Centre we actually have nothing much to offer....

The most exciting thing about Cancer of The cervix is that it can be detected early and early detection is tantamount to CURE....AS IN SERIOUSLY......CURED! HEALED! and what does it take.... a simple PAP SMEAR. Ladies, dudes with ladies in your lives, we all have mothers,we all have sisters and aunties, even the sister-in law you don't quite get along with... all it takes is a five minute procedure at the gynecologist clinic and we can eradicate this monster.

So, this week, if you do nothing else at all......please get a PAP smear done.....and at our facility, it just costs  a hundred bob! Come on people, PAP SMEAR PAP!

OF MY LOVER………SIIIIIIIGH!!!!!

So I have been missing in action…..been having exams, the stress, the adrenaline, the tension and worst of all the feeling that what I had read was not enough. Well, exams came and went and it went well. My name is now written in ink, and I can now walk with a little more pride in the corridors of our great institution.

So last week when I was busy trying to calm my queasy stomach and nerves for the impending exams, I watched an ARSENAL match. Well I thought the team was insignificant and nondescript and I knew that this was the game to watch in preparation for my exams….well…until I saw my ARSENALget whooped so badly, by the nondescript team….sorry, Liverpool.

Today, ARSENALplayed ManU. Today ARSENAL lost miserably. How in or under this earth does Van Persie miss a penalty like that one? (Am a chic, I could have done better) How do you ARSENAL get beaten 8(EIGHT) goals??? Is this you or QPR? (Or whatever that team is called). I remember when our affair started; my blood was always at boiling point when we engaged in games… I miss Henry, I relish the days of one Vierra… I fondly remember the days when Walcott ran like a bullet across the field. Cesc, my love, the most handsomest Spanish man walking, Gregarious Gallas, the Persie of hat tricks, Smooth and innocent Nasri, my white haired allure that was Almunia…(well, until he became a kin-chu-ngi!), the Bartender who would sometimes make us scream in delight and other times wail in grief!I I could go on, with this list……Those were great days, great moments, and orgasmic meets!

Today, ARSENAL, you are full of all these young players…with all the letters of the alphabet! (ARSENE,what’s that about? Can’t even recognize you anymore! ARSENAL!) Six years, I have cried and I have laughed with you. I have borne ridicule from all quarters. I have put up with your disappointing rendezvous under the covers…each and every week. And what have I to show for this, nothing….am as barren as I was six years before I met you! The only thing I have to show for this union is a lot of dust and cobwebs.

So today, my LOVE, my ARSENAL, I move out of our bedroom. I will no longer be your bed fellow! Am tired, am disappointed, am heartbroken…but I have to do this. Enough is enough. Put your act together and maybe just maybe my eye will rove around for a more experienced, more gregarious, more alluring, a smoothie handsome, a lover with speed and hat tricks with an orgasmic finish.

I love you; I always have….will probably love you forever too.

of contraception......HORMONAL!

So I have sat in The Family Planning Clinic and I must admit that was a very exciting one.Women have tales to tell!!! One, almost 45year old stuck in my thoughts. She had come for insertion of a coil (IUCD)...OK before you start wondering why this is a big deal, let me explain...sit back and  take a chill pill. The said woman had been widowed for over ten years and she swore she had had not other relations and thus I gave her a look of so why bother now and you're almost hitting menopause.....??She went on to tell me a tall tale about how a certain young man (young enough to be her son), who was a husband to another woman in her women's group had been throwing darts her way.....she told me she just wanted to be on the safe side in the "unlikely" event that this "young" man would get his way with her...(I doubt that she hadn't already tried him out! WINK)But I didn't judge...I happily gave her what she wanted but I thought of something....here is a woman, in the prime of her life, going after her own "happiness" and taking control of it......mmmmmmh!

The commonest complaint in that one week I spent there was "lack of" or reduced libido.....commonest culprit....hormonal contraceptives! God in his infinite wisdom as he created the menstrual cycle in woman, planned it to the last detail...!! Around the time when ovulation is about to occur, estrogen is produced in copious amounts, this estrogen causes the vaginal secretions to be clear, and it is alot...overall effect..increased wetness. Just when the egg has been released, there's also some testosterone that is released and in women this  is the hormone that increases libido....even the temperature rises!!! So the woman is so to speak...at her peak....(this may sound bad but it can be equated to being "on heat") and if coitus takes place, a baby is very likely to be conceived at this point, but in the event that this is not desired other methods are used like condoms etc to prevent it!

Now the sad part of all this is that hormonal contraceptives(The Pill, Patch, Implants etc)...well....blunt this very exciting phase in the woman and many a men are left wondering what happened to their once hot blooded, ready to have sex chic they had dated initially....you know, the one who used to call and ask for it with the urgency of a firefighter on a mission...the one who'd get so turned on from a single kiss....and for fear of sounding like am on a Mills and Boon series, I will end it there, but you do get the drift (are those books sold anymore???)

So guys, sometimes the answer is right in front of you, ladies, if you want to get that control back....look for better options and yeah, enjoy that part of life...before physiology fails you in the later years!

OF A FAILING HEART...

So the other day we admitted a patient with a severe heart condition at 26 weeks gestation. She had rheumatic heart disease...(that one caused by untreated throat infections that then spread and cause your heart untold grief....). She had severe Mitral  valve stenosis with elevated pulmonary pressures. Now pregnancy as much as it produces a smile and a bouncing bundle of joy also wrecks alot of havoc on a woman's body (Now this is one reason why every woman should be respected....especially after she has carried a baby to term.....)One of the systems that is badly battered is usually the heart. So the patient is admitted because the pregnancy was taking a toll on her weak heart for intervention.

Now in this part of the world, resources are limited and scarce (ahsanteni AKUH for the brand new cardiac unit.....). A cardiologist reviewed the patient and he suggested they could do a minimally invasive procedure where they pass a catheter from the patients thigh to her heart through a blood vessel and try and open up the blockage. Well that was welcome news..wow...a solution! Damn problem, The Cath Lab that does all those procedures has been accumulating serious dust and all those funny creatures! It has been out of order for...eh....ah.....DOG YEARS! Now as much as it can be done in other units, the operation costs two arms and six feet! And my patient didn't have such resources sadly.

The other option we offered was terminate the pregnancy, save her ailing heart then plan for the operation later. Only problem was,the pregnancy was quite advanced, terminating it would cause more harm than good the seniors shuddered at that option. I had a chat with her and offered the options, we were stuck. Her husband was even more lost (aren't men always lost on such issues??)

Then along came our knight in shining armour... Cardiothoracic team. They said they could try open heart surgery and replace her valve with one of those brand new shiny ones(I think they're cool....you can hear every heart beat as a click!!! ) OK, we were stuck really, and there was no way we would keep her in the ward and just watch her waste away, something had to be done. We prepared her for theatre, haggled and begged for an ICU bed post op and finally she was taken to theatre.

She managed almost 2hours on the fancy heart lung bypass, another two hours of....... (Honestly I don't know what they do, but I really admire their skill, holding the heart in ones fingers and feeling it stop beating and after all that, feel it beat all over again once the whole operation is done... I think it must feel exhilarating!) So she pulled through it and she awoke in ICU. She was even breathing on her own, without all those tubes down her throat....until some 24hours later, complications arose, she threw a clot and in a matter of minutes....she was gone.

We lost them both. Could we have lost her if we did nothing? Very likely. But we still lost them when we did something.

Such is the life we live day in, day out :-(

OF CORD PROLAPSE

So the other day I was doing theatre duty.... I love it, the adrenaline with every operation gives me a high...I also hate it as well. The whole theatre list is fully and totally managed by the nursing team. They decide which patient is to be received in theatre, what time and when the operation starts....It is absolutely annoying when especially the colleague running labour ward is having a bad day...meaning, he has bad patients and most of his decisions end up with an emergency c-section. so the poor doctor has a long list of patients waiting to be sectioned, whilst theatre team are up in arms as to who and when each operation will take place. And it is especially horrendous around that time that the shifts are changing! Many a doctor have cursed out loud, raised a voice, stamped feet in annoyance but oh well....c'est la vie!


Luckily for me, I had a calm day, my colleague in labour ward had an even calmer ward. So by almost end of my twelve hour shift we were working well in sync and sorting out patients slowly as they trickled in. Now when I had just scrubbed in for my last patient, I heard the dreaded words that turns theatre into a real ER_ Yeah I mean ER the series.....the one where everything from a broken toe nail to a broken neck is treated as an emergency....I think watching ER in my hey days played a big role in my choice of career, those doctors and nurses always looked so sharp, so eager to save a life...and I loved the authority that doctors wielded in the series. The doc would just lift his hand ask for a scalpel or whatever and the nurses would scamper off..literally in search of one and quickly offer it to the doctor. The technical gadgets and instruments, funky theatre gear, and the adrenaline....oooooh.... YEAH, UNTIL I DID THE MEDICINE AND THE AFRICAN REALITY HIT HOME! ( I no longer watch ER, I get depressed, plus I now know well....These guys are just acting...in real life...this can't happen....or can it???)

So where was I? yeah, someone shouted, "Cord prolapse!"....WHAT? the tempo in theatre suddenly changed, the air electric. My patient had already been put under, so me and my scrub nurse had to go on with our operation...the rest of the team save for our anaesthetist quickly rushed to the next theatre, it was cleaned in milliseconds, the scrub nurse had already taken out the theatre set and arranged it, srubbed...the doctor manning labour ward jumped over into theatre, changed into theatre garb(He was even given shoes which we usually have to hide for our own use, they materialised from somewhere) and quickly srubbed. By this time an anaesthtist from ICU had been summoned and patient was put under general anaesthesia.... Before the patient had the breathing tube down her throat, the abdomen had been opened and the blessed baby let out a high pitched cry!(Not to worry, she was heavily sedated and paralysed by the anaesthesia). Yes, He was alive!! Ok...this whole process took less than ten minutes...seriously!

So can we have ER in our unit...of course yes, only if the people concerned are willing to..but YES WE CAN!

of A GIRL AND HER SALONIST

Now, guys who follow my blog might get lost on this one.....forgive me.

So yesterday I had a free afternoon and my hair was a mess....I quickly called up my salonist and he said he was unwell and put on bed rest for a week!A whole week? Bed rest? A guy??? did I ask again? A week? A guy? KWANI what is he suffering from??? I happen to have a haircut, and truth be told he has done a good job so far...three years nowand counting. But last week he got cocky and over cut my cut! I was pissed....but it still looked OK, just not my signature style... And now here he was saying he is on bed rest...COCKY! ARROGANT!MEAN! PRETENTIOUS!(does this even apply to his case??)

So I had only yesterday free and I said in my head, that he is not the only one who can make my hair...who the hell does he think he is? NKT! So along I went and the other guy in the salon tried his hand at it. And from the word go I knew I had made a grim mistake! Dude didn't even know the comb from the curling tongs! (OK am exaggerating) but the end result I left the salon looking like I had a limp mop hanging on my head....DISASTER! Am not the kind to cause a scene, and even if I had, he didn't force me to make my hair...I allowed him..I walked to my car and screamed at the image staring back at me from the side mirror! WHAAAAT?

I couldn't be seen dead in such a hairdo! I went in search of another salon and did the unimaginable...I swallowed my pride and confessed that I wanted my hair re-done( I found this very humbling). So the salonist, this time a chic said she would sort put my 'little problem'(was that a smile I saw at the corner of her mouth? was she laughing at the hairdo I was sporting? or the sheer look of desperation on my face?) needless to say, she tried her hand at it, end result, not too bad, definitely better than my previous experience but when I combed my hair this morning....I Miss my SALONIST!

He knows my hair, he knows my style, I always leave the salon with a smile on my face and sexy bouncy hair. So, on Monday, I will forgive him for his 'impunity', I will take his crap...I will make do with bed rest....I will ignore his cockiness, his arrogance and put up with his drama....because, I NEED HIM. My hair and I can't live without him!

*SIGH*

of pediatricians

So this day am doing my ward round. Usually am assigned the room with the mothers who have just delivered( I think it has something to do with my smile.....LOL) Now as an upcoming obstetrician, my main focus more often than not lies with the mother...how she is doing after the c-section, is she able to walk,is the pain well controlled, are her breasts full of milk for her baby or engorged and painful? is the uterus well contracted and the blood loss acceptable etc. then I give instructions on what to do for the day...on Day 1 I want her to walk, eat a light meal and breastfeed, day 2...normal diet and I want to see her up and about,discuss contraception etc day 3 I expose the scar and she is ready to go home! It sounds all very routine like and easy but if you've been in such a ward or situation you also know that these new mothers tend to have a million questions and you have to  answer all of them, give an encouraging word here and there, offer a helping hand to the one trying to get out of bed etc

Usually I personally also peep at the newborn(I have a thing for babies...all my friends and my mum thought  I was cut out for pa-eds, well....until.....) So on this particular day I was on my  usual routine, it was especially interesting since I had been in theatre the previous day and some of the ladies i had seen I had actually operated on them, so it was nice seeing my workmanship and the sweet outcomes. When I got to this lady's bed, I started asking her how she slept and if she had any complaints. I then looked at her baby and she looked 'odd'. Baby had her eyes shut. I tried to nudge her awake..first with a light touch then more urgently and vigorously when I got no response. I asked the mother how long she had been like that and she said the baby had been asleep. I took the one day old bundle in my arms, told the mother to follow me and I rushed her to The New Born Unit.

When I arrived, I found my long time friend on call....she quickly initiated resuscitation attempts and after 20minutes the look in her eye said it all. I felt tears well in my eyes...I confessed that I was in no situation to tell the mum the sad news and she took it from there. I remember going back to the ward and giving the mothers a long pep talk....I had tears in my eyes and a very heavy heart...quite a sad start to a beautiful morning....

How pediatricians can cope with such losses, I simply can't imagine and this goes out to all those baby doctors, for all the hard work you do and all the mothers you have to deal with especially after the loss of a small child.

My friend Martha, am so sorry for your loss, But the Good Lord will see you through this trying moment...and you will smile again.

And my next post surely should have a happy ending!

of Aunt Selina

It has been ages since I was here, my laptop crashed and yeah...it was very lonely without it...AS In SERIOUSLY!!

So today am here and am sad, My aunt Selina is battling for her life in hospital...let me share her story. I have to say I didn't know her so well initially. She is married to my mum's small bro. She was always so quiet but very jolly with a smile that lit any room she walked into. So auntie was diagnosed with breast cancer early last year. As the designate family doc am usually sent ahead of the whole battalion to get the medical info simplified then I lay it down in simple words. On the day I saw her in hospital, she was the calmest soul  I have met so far....mind you she had just undergone a radical mastectomy(at this point it is OK to google). And she told me the sequence of events that led to that surgery and how her doc didn't even give her a chance to think about the mastectomy and how she had been rushed to theatre  only to wake up with the left breast missing...OK, fine am a medic and these things we see day in day out but whenever it happens  to our own, the shoe totally sucks and smells whilst on the other foot!!
So auntie had surgery and immediately started on chemotherapy. I remember calling her and she would be the one giving me encouragement that it shall be well and we were going to fight this..(NB:...WE) as in she was always the stronger one. A few months later she convulsed in her house, rushed to hospital, and my worst fears were confirmed, the damn monster had reared his ugly head into my aunt's brain, when the doc told her what was going on, I saw the slightest flicker of fear, discouragement and sadness which was quickly replaced by a smile and determination, her words, we will beat this! She then embarked on another ravaging course of chemotherapy and radiotherapy, always smiling, always forging ahead, always strong willed and that smile....that one that lit any room she walked into.

Two days ago, I called her, she had just come from hospital, after a blood transfusion and she told me she felt great, she felt a real improvement and this time....WE HAD BEATEN IT! I smiled....I knew she was smiling too. That was two days ago......Today, she lay on the ICU bed, tubes running allover in and out of her, her head bald...from the chemotherapy effects. I talked to her...I hope she could hear me. Auntie...we WILL BEAT this, but above all, God, let your will be done.

OF THE "DOUBLE O"

So this day am in labour ward, the most dreaded twelve hours we each get....yaani by the time am done with each call I sleep for like twelve straight hours and still end up with aches and pains even in places you can't possibly imagine!!! But I love it, the screams, the curses, the adrenaline and best of all the smiles of mothers and cries of  new babies...totally fulfilling, I always head back home with high spirits in a battered body though!

A young university girl studying in Makerere caught my attention and we just started chatting, she told me the usual story of girl meets boy, girl gets pregnant, boy and girl don't want to get married so quick under the guise of the baby so they are waiting for the right time, come on people........come on, you will eventually get married so WHY NOT JUST DO IT ANYWAY BABY GUISE/ PRESSURE OR NOT???? Lol! Now to medical issues ahem! so during the ward round when we get to the bedside, the CTG (It is a machine that records the baby's heart rate in the mother's belly, and helps us monitor baby's condition during labour) appears abnormal. The baby's heart rate was dipping and rising in a very characteristic pattern. So the consultant asks what we think is happening and I quickly say that the baby seems to be having an element of distress. He takes this discussion a notch higher and asks in what condition do you see this an d I stare at him blankly.

For those who know the Double O know that that is a teaching opportunity and he grabs it. He says that that kind of pattern is seen when there's a loop of cord being compressed by the baby on the shoulder against the mother's pelvis or in cases where the cord is extremely short. Advice,assess the lady and watch the baby's condition and in the event that there's significant compromise I plan for an emergency C-section. I get back to our patient after seeing the rest of the patients. On doing a vaginal exam she is 4cm dilated, a quick ARM(artificial rapture of membranes which is done to expedite delivery) reveals meconium like Grade 6!!(OK, meaning baby has passed stool in the uterus and this is a sign of fetal distress i.e. fetal well being is threatened)

Our emergency theatre is occupied and in such an instance there is no room for waiting so matron manages to get us a theatre upstairs and I have to scrub in and save this baby...(Did I say I love the adrenaline rush???). Well, I get into the uterus and deliver the baby covered in greenish stool, but the most amazing thing is that as soon as the baby was out the placenta followed spontaneously, reason being?? The cord was so short....like 10cm long( a normal umbilical cord averages a length of 50cm!), If we had allowed the lady to continue with normal labour, or had we delayed the artificial rapture of membranes at that point, the baby would have descended into the pelvic canal and the short cord would have pulled the placenta along with it causing sudden detachment called placenta abrutio and the baby would have bled out and died! And you don't want to imagine what we would be dealing with to save the mother's life!

It was a victory for me, I almost high fived my consultant for his "wisdom" and definite experience which saved a life! At that point I had so much respect for the double O, I had a new insight into the saying experience is the best teacher! I hope my patient has now gotten married to her baby daddy.......(a story for another day!)

On a different note, today I delivered a footling breech(case where the babies legs are delivered first instead of the head), yeah one of those difficult cases where the cervix is not fully dilated so the head gets "stuck"....many manoeuvres and baby was out! little victories!

Night people!

OF GOVERNMENT HOSPITAL

So this time round I ended up wearing a totally different hat. My niece who is five months old had been sickly on and off, she lives with my brother and his wife in Nakuru. For the past month or so I have been giving over the phone advice on whether the medicine they received at the local clinic was good and what it was for. My pediatric colleagues have time and time again warned about phone consultations...and any good doctor worth their salt knows that those consultations don't work. If you are sick, please just go to hospital, saves a whole lot of people a whole lot of complications...I digress again!So mum calls me and says that the ka baby doesn't look too good and she's worried. Of course, most of the times grandmas judgement is not to be ignored.

We arrange to send some money over so that the baby is taken to a pediatrician in Nakuru town, at least for a thorough assessment. So they take the baby to a "doc" who on seeing the infant sends them to Nakuru PGH for further evaluation. When they get there, they are quickly told that the baby needs admission. They go through the motions and baby is admitted in hospital. as a doc I know that if a Govt Hosp recommended admission the situation is dire so I get a bit apprehensive but I know that all hospitals in this country are well equipped to deal with all under fives ailments.

Come morning, mum calls me, literally in tears. Her granddaughter has been put on oxygen! ( I don't know why this statement always throws people in a panic, sometimes when am so tired from one of those crazy shifts I wish I could get some oxygen down my nostrils and reduce the effort of breathing as I rest.........!!! Again, I digress) Of course I also get concerned and decide to drive down to see my niece. And being the "family doctor" my mother would feel more at ease.

When I get to the hospital, I mean.....I can't even begin to explain what I felt. I was totally unprepared for it. The Pediatric ward is one long room, very long! Beds are arranged along the walls, reminds me of my dormitory room in primary school. The ward is stuffy, I mean....really really stuffy, I doubt there's any oxygen in the air. The ward is teeming with all kinds of people, sick babies with their mothers looking worried, others screaming their little lungs away, concerned and confused fathers hanging around, other visitors all carrying different wares(read food) for the patients. two doctors are working in a corner shaving the poor scalp of a screaming baby desperately looking for IV access to give fluids to the obviously dehydrated child.

I ask for my niece and the friendly nurses(shockingly) point at a station and says she is in the acute room. (Acute room is where the really sick babies are put for easy and frequent monitoring or oxygen etc). Now, this particular acute room is just a bed in the big general stuffy ward, with like seven babies all on oxygen coming form a single oxygen unit with multiple small tubes each directed towards the sick babies. The mothers are seated on a bench, each trying to ensure that the oxygen tube to their baby is not yanked off by the desperate kicks of the child lying next to hers.

My niece was suffering from severe pneumonia and her chest was moving up and down so fast. The other six babies next to her looked equally sick and all were gasping and holding on to dear life. I wondered, in such a situation, does the child get better or worse? Poor ventilation, overcrowding? Hospital acquired infections? Spread of the gazillion strains of bacteria in that ward let alone "The acute room".

Lucky for her, we managed to transfer her to a private hospital, the difference was glaring! private room, toiletries, air....oh, the air!!The little girl is off oxygen now, markedly improved but still on IV antibiotics for a couple of more days. My heart goes out to the other mothers I left seated on the "acute room" bench hoping and praying for their little ones..... God works overtime for his people and am sure they will get better, but today, I take a moment to Thank God that I can afford the basics in life. And asking our good God, to please help our Government.......Our People...the poor six i left on the "acute room" in Nakuru PGH and the many doctors working out there, effortlessly making do with what you have!

NEWEST ANGEL

So last week, my very good friend calls me up, she is thirty five weeks and tells me she is not feeling her baby kicking well.... For those of you following me on my blog know that that has been my nightmare and i am forgiven kindly for feeling my heart sink down to my toes in that very instant!! I quickly call her and ask her calmly but inside am almost losing it...whether she has gone to see her doc. She calmly tells me a long and short story of how her obstetrician sent her for an urgent scan but because she got got up in the queue at the radiology unit, she decided to take the report next day. I ask her to read out the report for me. Scan says theres a single loop of cord around the neck, theres reduced amniotic fluid, fetal movements and heart rate are good plus the doppler blood flow is satisfactory.

So we agree that first thing in the morning she goes to see her doc. Next day am unable to let it go so I accompany her to the Obstetrician's clinic and we gossip, talk about shoes etc (girls you know what I mean) to while away time. She sees the daktari who "prescribes" a csection. So she comes out, and is to be admitted first thing in the morning for an immediate section. Am abit tense, 35 weeks the baby's lungs are well matured but haven't we had cases of babies at 37 weeks with respiratory problems? Do we buy a little time to forgo this? 20% of babies are born with cord around the neck, out of these only 2% have complications...( One of my lecturers had jokingly told us that he tells radiologist not to report cord around the neck unless it is significantly tight as it just causes undue stress on both the mother and her doctor....), so is this justification enough. On the other hand she has reduced fetal movements....which is the better angel or lesser devil??

She goes home and I tell her to have a fetal kick chart and I will call her after a few hours we see if its satisfactory. 6hours later I make the call and she reports only 3 measly movements. Not to seemed too alarmed I tell her to keep checking but she should call her doctor and arrange for an immediate section, this doesn't sound good. I have never had such a long night, I kept thinking can morning come, God please take care of my friend and her baby, please God, Please....

The long and the short of it is that she is a very proud mother as we speak, baby weighed over 2 and a half kilos. he joined the mother on the second day and he is breastfeeding away at home, no sign of any compromise on his breathing.

Lesson of the day, a happy and wide smile for all of us. And am asking God for strength and wisdom like our lovely ever so wonderful Obstetrician for making the right call.

OBSTETRIC NIGHTMARE

Two weeks ago, a lady walks into the consultation room. Heavy set lady in her late thirties, well dressed. On looking at her card, i see she is on follow up for Gestation Diabetes Melitus(Diabetes that develops during pregnancy). On closer scrutiny she is at around 37 weeks. Patient reports feeling exhausted and she just wants the baby out. she is tired! (Well, for those who have been pregnant,  this feeling is not too uncommon, sometimes you just want it over...) Since she had been seen earlier she is wielding an ultrasound scan to check on the general well being of the baby. Quick scan through the report shows a Live fetus, at around 38weeks with a perfect biophysical score of 8/8. I reassure her and tell her i will give her one week, so that we can at least buy time so that the baby reaches 38weeks then we can induce labor. the lady says that she is tired and she doesn't feel the baby moving as well as before. I reassure her and say we have a perfect score so to keep a fetal kick chart and if less than 10 in twelve hours, she should come to labor ward immediately.

Exactly a week later, she returns. this time I can tell she has really reached the end of the road. I do a quick examination on her. I ask her how her week was, she says she hasn't felt her baby kick in two days! The first alarm bells go off in my head! I do a quick examination, unfortunately I don't auscultate a fetal heart. She is heavy set, a huge fat padding over the anterior abdominal wall so i give myself hope that maybe just maybe that is causing the difficulty in perception of the fetal heart. I ask two of my colleagues to try with no luck. I tell her with the steadiest voice that I can muster that we need to do an urgent scan to determine how the baby is doing. Deep down, I feel a dark and empty pit slowly creeping in my tummy.

We do a quick scan that reveals that we have fetal demise! have you ever felt like a ton of bricks has landed on your face, back and head all at the same time? Am faced with the difficult task of breaking the news to the mother. I pull myself together and tell her in gentle tones what has happened, there's no way to sugar coat the issue, it is as it is.... She goes stark quiet for a second or two, then the floods begin, and I feel so helpless......then the shock sets in and anger rears its ugly head! She wails out loud, "My baby was fine one week ago, You should have delivered me then..."............ WHAT??

Should we have delivered her then and risk respiratory distress syndrome? We had a perfect score of 8/8...
She also waited two days with absolutely no perception of fetal movements and she didn't come earlier.
What to do, who to blame, where to go from there?

Dark abyss, an absolute nightmare!

OF PRAYER

Yesterday I was on  night duty, Emergency Theater Call. and being a Sunday and all, I felt the urge to whisper a prayer (My pastor would be proud of this one) for all my patients before my scalpel cut through their bellies to bring forth new life, it was also mothers day so I was kinda mellowed out and hoping that everyone who came under my blade would get to experience the true joy of motherhood.

All went well, needless to say but one patient gave us a little fright. She had a very Low Hb level...i.e she was really anemic, her baby developed distress and she therefore had to undergo an emergency c-section. I remember praying fervently each step of the process and asking God to give us a bloodless operation because The National Hospital as it were is having a blood crisis! Thankfully, The Big Guy up there never disappoints and we pulled through, baby wailed her lungs out and mother recovered uneventfully.

Brings me to the all important question, how many of us commit our patients under the Almighty.....


Blessed week people!

so low....

Today I had one of those very sad days......something went horribly wrong, this is when I realise that being a doc is a lot to do with brains but far much more, under powers that we can't control... to all the departed souls, born and unborn, here is to you and a prayer to God to grant us all Grace to wake up tomorrow and do what we do under his protective spirit!

The silver lining lies in this patient who bought me a soda.... literally! I don't know what it is i said, or how i said it that made her so happy, Thanks my dear friend. Its little things like those that give me the courage to smile and face tomorrow.

Goodnight pals!

Long time since I was here......but am back, and spreading a smile to people, well....trying.

Today my biff is with men who force themselves on women...oh heck, why am I sugarcoating it??? RAPISTS!
A young girl, in her early twenties walks into the consultation room, she is small bodied, well dressed, decent young girl. a student in one of the universities. She proceeds to narrate to me the goings on of the previous night...she had been on her way to visit her boyfriend, unfortunately the pathway to the apartment complex was dark and deserted. Fortunately for her, a policeman joined her on the path and offered to escort her through the menacing darkness.{ Come on girls, we all have a weakness for a man in uniform..(Prince William in his majestic wedding day outfit quickly comes to mind...I digress)} As they progress along the poorly lit path another cop turns up and before she knows it the poor girl is thrown into a deserted structure by the "good Samaritan cop"...who goes ahead and does stuff I can not even bring myself to recall. All this while, His "friend" is looking out for him, to finish his rendezvous!

Poor girl after the heinous act was over, stumbled to her boyfriend's house a few yards away....did what comes most naturally to most, showered and changed her clothes then went to report the case to the nearest police station(The IRONY!). She then had to see a doctor to fill in the forms required and do a medical examination and collect any forensic evidence so as to aid in the persecution of the assailant. I do what i can, but in terms of forensic evidence, am at a loss...the evidence was washed away....

By the time am done with my examination of the survivor, she is grief stricken, she has cried her heart out, she looks so vulnerable, lost, defiled, damaged, sad, suspicious, scared, mortified........ a small tear escaped from my eye, all i wanted to do is hug her and hold her tight and tell her its not her fault, we will get the bastard and possibly consider killing him!!!

But the law is the law and we have to respect the motions....but were it up to me, ALL RAPISTS SHOULD BE CASTRATED!(Chemical/Physical-burdizzo would be a plan) Then put in a deep deep dungeon to die a slow, sad, painful death! And when it is from those meant to protect us....the punishment should be..........

Lets stay safe! and there's a campaign called "Sitakimya" am behind it all the way!

SELFLESS LOVE

So now guys, we come to the Easter season. Let's pose for a moment and ponder on the thought that He Gave up His only son so that we may be saved. He died to save us from eternal condemnation. As we take a break from the busy life(well, those of us who are lucky enough to), let us be thankful to God and just take time to whisper a prayer, for ourselves, for our families and even our friends. I get to spend like five full days with my children and family, I will miss him...but he is with us in spirit....(sob, sob).

So today we were in theater, doing a tuboplasty operation. This lady is married for the last three years, has tried in vain to get children with no luck whatsoever. Husband  has been subjected to all manner of tests (even the closed door one,magazines...dudes you know what I mean) with no baby in sight! So all her hope lay in us as we went in to do some "magic" and grant her her wish! So in we go, scalpel in hand, methylene blue dye in another, retractors, sutures the full battalion!

What we get is just heart wrenching to say the least. Her tubes are thickened, tortous, with so many adhesions we couldn't possibly tell what lay where and when! her uterus is small and 'fixed' adhesions all over the place, her ovaries a mixed mish mash of tissue and more adhesions!

How many  times have we sat back and truly thanked God for the little things we have? I jokingly call my kids brats, but how many people out there are struggling to just give forth a new life to just nurture and watch grow? am left with the difficult task of letting this lady know that she needs to look for other options of getting a child(IVF and the like which is like un-affordable) or adoption(Quite another challenging option).

So ladies, gentlemen seek treatment for those discharges that come every so often for some or once in a lifetime in others, you could just save yourself and your future progeny! God gave his only son for us, Do you appreciate the chance he has given you in raising your kids...current and future ones?

Blessed Easter!

OF SEXY THINGS

So today I went to this symposium and all the big shots in Obstertrics & Gynecology were there. There was lots of new stuff to learn, controversial things to discuss and of course the usual hobnobbing! What struck my attention today was this very sexy, 6inch, red stiletto heels!!! I could sell my soul(well...almost) to have tried that shoe, but alas, it was an ad from a drug company, advertising well....a DRUG!!! That to me was one very creative way to do it and of course it will be imprinted in my memory for a really really really long time so guess that particular company will get quite a large number of prescriptions from me!!

That ad got me thinking, I have this black and red very little item of clothing I own and every time I put it on, I feel very sexy and no one and nobody could take away that feeling from me all day. I walk tall, I feel good, tingly all over, I have a certain swing in my stride, a lilt in my voice, I love it!!

So ladies, (well, do men experience this???) what one thing or two or three give you that instant sexy feeling?