OF SAFE ABORTIONS

So today's I was in this very interesting Scientific Seminar for Obstetricians and Gynaecologists. A lot of information and knowledge being disseminated left, right and centre. I need a shot of something nice actually, am saturated!

So we had this very interesting presentation on safe abortions. Well, before you all start throwing words and personal opinions at me, the Constitution of Kenya has a clause for this. Medics are allowed to perform this in the situation where the life of the mother and/or the baby is at risk. I won't go into the legal mumble jumble of it all plus the debate of when life starts because this we can discuss until the cows come back to "roost"...they already did, too late in the day!

Let me bring this situation home. Abortions are carried out in this country, all over the world, every minute. Every 8 minutes, a woman dies to an unsafe abortion, that is the sad story. UNSAFE ABORTION! Quacks out there, even some medical people are doing very shoddy things out there because this issue is shrouded in shame, darkness and controversy. In my institution, we attend to mothers who come in bleeding, and I mean really BLEEDING and most from a "quack" who started something they can not finish. Do we lose some? Of course we do. Some end up with such horrible infections that leave them scarred for life, as in literally, BARREN. Some come with their intestines coming out from the vagina, I don't even want to discuss that now!

So today, the woman has rights. Right to seek and get treatment. Of course when she comes in bleeding, as a doctor and as a gynaecologist, I do what needs to be done, I empty the uterus and voila, the bleeding stops, the unborn life is gone but I get to save the woman, never mind the blood transfusions, the antibiotics, the drama that precedes this. But she gets to live another day and decide when to conceive and she also goes home with a healthy uterus. it was clean, it was safe, she chose and she lived. Lived to plan and carry another pregnancy to term when she is ready for it.

I am a woman, women can be very adamant. If a woman decides that she doesn't want to carry her pregnancy and wants a termination, she will do it, by whatever means necessary. So in reality, when she walks to my office and declares the forbidden words, I don't want it...what do I do? If I say no, she will walk to the next dark, shoddy and inexperienced "practitioner" who will definitely do something, anything.....then things will go wrong she will come back to me to fix the mess......an ugly mess, sometimes a mess which will not be reversible and may lead to a loss. If I offer her the service, that is safe and under professional care the law would be on my ass plus unless I prove that it was a health risk to her...Damned if I do, Damned if I don't!

So ladies, (and GENTLEMEN) if you know you are having unprotected sex, (and please this would be suicidal if you're not married/in a long term relationship with one partner who is HIV negative) save us and yourselves this situation, USE PROTECTION, WEAR A CONDOM or USE A LONG TERM CONTRACEPTION, otherwise, Man up, and woman up and deal with the consequences of your actions!

Some medics kill the unborn babies, making the womb a tomb, yet others kill the mothers by doing nothing ! Catch 22? No, me thinks, catch 2222!

OF BLOOD........loads of it!

So did I say I was doing what I do best and with a smile....? It ended on a very low note.... So this patient comes in, a referral from one of the sub district hospitals around which I personally think should be shut down and the keys thrown in the ocean. Woman had delivered well, to a bouncing baby boy then she developed severe post partum hemorrhage...(bleeding following delivery). We received her in labour ward and for like two hours she had a bevy of doctors doing this and that for her....fixing IV lines, drawing blood, examining her, writing notes you name it! Despite all our efforts, the bleeding persisted And we rushed her to theatre to remove her uterus, that really is the last resort in such situations. We talked to her husband, explained the whole situation to him and told him that we needed to do that operation and since she was not coherent enough, he had to give us the consent. Poor dude was so lost and confused in that moment he consulted the patients sister, I guess just for reassurance. He eventually signed the consent.


I got to scrub in with one of the greatest OBGYN consultants in this part of the world, and oh my, does he have a wealth of knowledge and he is so humble, down to earth and also quite humorous. His dexterity is also unmatched. So we do a sub total hysterectomy in like thirty minutes and we close the patient. When I was closing the skin blood was now bright red and we were all quite pleased.

One hour later, all hell decides to break loose. Our patient goes into shock all over again, on further examination, she was very pale. Conclusion, our patient had initially lost so much blood that all the factors that assist in clotting had disappeared. Se was in a state called DIC(most docs call this, Death Is Coming but medically speaking it stands for disseminated intravascular coagulopathy). My consultant is called back, patient is rushed back to theatre a second time, but she codes on the table.

My patient, at some point before we operated on her, she talked to her sister, she even talked to the anaesthetist and she was actually telling him to take heart, God is in control. I can't even begin to imagine how we break the news to her husband, to her sister, to the son she will never get to know....... <SIGH>

OF TRIPLETS!!!!

So it has been a while since I appeared here! well, it has been kinda drab and boring, well, until today!! I was doing the maternity theatre shift today, it was exciting as always....well save for me starting my list at midday and doing only two cases instead of the seven lists that were waiting for me, well my friends, that is a story for another day!
My colleague was operating on a young lady, well about 27 years of age. She was thirty six weeks and carrying triplets! Yeah, I know most of you are now saying wow, so sweet, so lucky....TRIPLETS! SIGH! And this was her first pregnancy! Wow! So my colleague delivered one, then two and finally the last one, ALL BOYS! Big, pink, feisty, hungry BOYS! And for her to have managed to reach 36 weeks with triplets was quite an amazing feat, yeah you can imagine all of us were just marvelling...well until we got wind of her social history.

It so happens, that this young lady is single, living at her mothers house, hopefully she has a steady job. As soon as her Baby daddy(Of triplets) found out that she was pregnant, he upped and left! never to be seen or heard of again.Now this young mother (of three) is left to raise her three boys all alone, thankfully with the help of her mother. I have a son, he put me through hell and I mean, real trouble...he could suck me dry and he was alone, I can only imagine what three little hungry boys will be up to! She will probably have to employ two nannies at the very least, feed herself like crazy to provide milk for the boys and well well well, I can't even imagine what kind of mischief these little ones will be up to once they start walking and taking....so adorable!

But today, I only ask myself one question....how does this man feel? Does he know he is a father to three really sweet and feisty little boys? Does he really want them to grow up never knowing their father? Does he sit with his fellow men and act like a man knowing he abandoned three little, cute, sorry, handsome, but so adorable little boys to a life of not having a daddy? Does he feel any guilt? Any shame? 

But for all those men out there who have sown their seed wild or otherwise and let the Hapless mother tend to the garden and reap the harvest all on her own and walked away, without a care, without a second thought and without the balls to Man up and take care of your progeny, SHAME ON YOU! And to use the words of Steve Jobs, you are just Fucking Dickless Assholes!

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>