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!