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!
Thursday 26 May 2011
Thursday 19 May 2011
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!
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!
Monday 16 May 2011
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.
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.
Monday 9 May 2011
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!
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!
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!
Thursday 5 May 2011
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!
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!
Monday 2 May 2011
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!
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!
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