Of a destructive delivery

So, I have been on a long sabbatical. It's been great ! Met a lot of cool people in the past year, Learnt a lot of surgery and other fancy medical stuff. Oh and I got to spend loads of quality time with family, wedding bands and beaches! 2012 was magical in every sense of the word.
Like every other good thing, it had to come to an end and I am now back to my passion, OBGYN! Yesterday, I was in labor ward all day, doing what I love....(well, today every muscle in my being is screaming murder). The boss came early to do the handover round as we all wanted to go catch the presidential debate(Very considerate Chap). We finished in good time and just as we were about to leave, a midwife calls us to go handle an emergency. *REALLY,????

This lady had just been wheeled into labor ward in Second Stage(meaning her baby was ready to be delivered any moment). Well, that happens a lot only that in this case, her baby was in breech( a condition whereby the baby is born feet and legs first instead of the head).  The very competent midwife had delivered the baby's body but the head was "stuck " inside. In such a situation, the senior most midwife first goes in and tries maneuvering the baby, when that fails, the wide eyed Resident (read me) takes over....then the Consultant is the ultimate.

So in we go, follow protocol by the book and we all fail miserably. See, we notice that the baby has spina bifida(a birth defect on the spinal cord) and no matter what we do, the baby's head refuses to come out, and we are left with only one conclusion. This baby has hydrocephalus (condition where the baby has an extremely large head from accumulation of fluid, goes hand in hand with the Spina Bifida). By this time, the pink baby body we were seeing initially has turned dull and lifeless....

We rush the woman to theatre and hope that as we put her under GA, her muscles will relax and we can try deliver the head. Unfortunately this too fails and by now, the baby is lifeless, head snugly tight within the mother whilst the body wilts away. What we do next, can not be described in this post.......but the mother's life takes precedence over everything else.

Ladies,  when pregnant, just do an ultrasound, know what state the baby you are carrying is in. Had this happened in a different set up without the facilities we have, a mother and child would have both died. We got to save a mother, but we all love to have a healthy mother and baby!

Am ecstatic to be back, albeit on a sad note.... Keep reading!

OF SUPERSTARS

So, it has been really long since I last penned down my feelings.... here we go.

so, about a week ago, a friend of ours underwent a c-section at one of the best hospitals in this country. She checked herself in, and seeing as it was an elective procedure spirits were up and everyone was happy. She went into theater, delivered a healthy and I swear that baby was actually bouncing!!! Handsome little man...the ooooohs, and aaaaahs, and so sweet...flowed  and flowed some more.

One hour post op, all hell broke loose. No doctor is perfect, neither is any procedure routine and as it so happened, the new mummy's condition suddenly took a turn for the worse. She got restless and listless, started throwing up, her level of consciousness started waning and within no time, her BP was so low it was un recordable. For a surgeon, this could only mean one thing.....we have to go back in. Our patient was wheeled back to theatre and so started the long and dreadful wait.

First person to run into theater was two anesthesiologists, then a cardiologist, then the Obstetrician and finally the Cardiothoracic Surgeon. We waited and waited and waited some more. Now generally, you don't want the doctors coming out too soon cause that would mean it was too late and she didn't make it. Again if they take too long, it could mean that they are probably in there too exhausted and scared to tell us the sad news. That was the longest four hours of my life...the wait! My only consolation was that we were in the best hospital in this country and surely, with the best doctors on board, our patient had to live.

And so, they started trooping out...The superstar Cardiologist, he told us about how he managed the shock with epinephrine and inotropes and some fancy big drug names and reassured us she was out of danger. Next was the superstar Cardiothoracic surgeon who told us how he made a midline extended incision on the abdomen and followed the aorta from the xiphisternum all the way down to the aortic bifurcation and checked the iliac vessels and he had arrested the internal bleeding. Next was the superstar OBGYN, who told us the uterus was intact, well contracted and our patient was out of danger. Last but not least, was the two anesthesiologists who I can swear I even saw their hairs being blown like in the movies...the real superstars who wheeled our patient to ICU, connected all those fancy gadgets, told us long tales of FFPs, Platelets transfusion, monitoring the two drains in-situ, the fancy drugs to stabilize the BP at a low level cause they did not want her to start bleeding all over.... Our patient spent three days in ICU, and now recuperating albeit slowly in the ward now.

My point? How many of us doctors have these facilities wherever we work? How many have lost a patient due to bleeding because there was no blood? Because there was no FFPs and she went into DIC? Because the hospital does not have enough staff to do the run around? Because we did not have the Cardothoracic surgeon to help identify and ligate a bleeder? Because we did not have a cardiologist neither the inotropes to correct the shock? Because we did not have an ICU? Because we did not work in the best hospital in the country? Because we were too tired from working all day and with not even a penny to show for it?

Doctors are superstars! We save lives! We do our thing and people live. Bwana Minister, all we are asking for, very simply......listen to us, meet our demands and please please allow us to be SUPERSTARS! Cause that's just what we are! #peremendemovement continues.

OF UNSUNG HEROES

So, I remember my first day in labor ward, as a big eyed, very green and inexperienced intern. I was overwhelmed with first and foremost the miracle of childbirth and all the woman screaming away in labor pains and even more distracted by those who were pacing up and down the corridors. As it so often happens, the resident doctor on call was called off to theater and suddenly the whole labor ward was left under me. 

Now I think skiving all those fourth year labor ward duties came to bite me back and it bit hard! I had no idea what to do, where to do it and who to do it to. All the midwives were on my case each wanting me to review their patients (I think they smell a newbie, green eyed doctor from a kilometer away and I think they also derive pleasure from seeing the poor hapless doctor sweat....seriously!) Sweat, I did. A whole lot!

All I remember about that night was a lady who was about 28weeks having preterm labor telling me that she had an urge to pass stool. I gladly took her hand and led her to the washrooms! You can imagine my horror when she squatted right inside the door and pushed out the tiniest little baby I have ever seen....Thankfully not inside the toilet bowl, she didn't quite get there. I also CLEARLY remember the midwives screaming at me, some ridiculing me and others just laughed at this 'doctor'. <DEVASTATION>. One particular midwife saw the anguish, confusion, embarrassment (there are not enough verbs to describe my feelings at that point) and decided to help me out. And since then, most of what I know about obstetrics, I owe it to the midwives I have worked with over the years. 

As an OBGYN, I have learnt that the midwife is the one most powerful friend I could ever have. She knows when things are going on smoothly, she can tell a fetal distress from a mile, she can see an impending convulsion from behind the curtain, she can tell whether a mother will manage to push that baby out, or we need to do an operation. A good midwife will make a doctor have a smooth delivery or a complicated one, she can sass out abnormal contractions caused by abruptio placenta from the normal contractions of an overtly sensitized patient, she knows when to intervene when things are not going on so well, she knows how to talk to and encourage the woman in labor. She provides the motherly,caring  and reassuring touch when am busy trying to beat traffic to get there on time, she will always offer a comforting word, a shoulder when the unexpected happens. She will definitely warn me well in advance when she thinks things are not right, ignoring a midwife at this point is suicidal. 

Today, I salute all the midwives, who risk it all, who give their all, who brave difficult situations, who work tirelessly, to bring forth the miracle of birth. And to the Ugandan Midwife, up for the Nobel Prize, you deserve it and so much more! SALUTE!

THE OTHER SIDE OF FEAR

FOR MY COLLEAGUES WHO DAY IN DAY OUT ARE IN THE BUSINESS OF CARING FOR WOMEN

In giving birth some must go to the other side of fear.

They do not always realize how close it is from here.

May we who care for women travel with them there.

Let us be their guide as they traverse this length

Searching for their power, discovering inner strength.

Help them see in their mind’s eye the place where they must go.

Walk with them through that door thoughtfully and slow.

Then looking back toward where they began

They will know, with confidence, they won’t be there again.

They will embrace their child in an ever-greater sphere

After finding power on the other side of fear.

-Joan moon, CNM,MSN

Certified Nurse Midwife

Of LABOUR

So picture this, am this very young and impressionable fourth year medical student, fresh faced and eager to learn, full of zeal and zest for life, notepad in my slightly over sized lab coat, stethoscope hanging around my neck and with these big curious eyes taking in everything going on around me. So Innocent......So good were those days....

So there I was, on one of those random days, hanging around the hospital with nothing to do,and since I was doing my Obstetrics rotation I decided to just take a stroll to labour ward. I had heard stories, a lot of stories but I was in one of those carefree moods, nothing could faze me. Immediately I got in, there was some flurry of activity towards some small room at the back of the ward and everyone seemed to be headed there. I of course quickly joined in the procession and in my tiny little self I caught myself thinking that wow am gonna catch some action, what I saw really stopped me dead in my tracks, action , I did get, lots!

I realized that I was in the delivery room right in the thick of things. There on the delivery room was a lady, in her twenties or so, her legs high up in the air, astride and the room had several students, more eager eyed and stupefied than I was..the door to the delivery room was wide open and the other nurses went on caring for the other patients. The primary midwife was shouting at the lady ordering her to push the baby out lest the baby gets "tired" in the birth canal. The room was such a flurry of action, students whispering and pointing at the baby's head peeping through from the nether regions, the midwife hurling orders left, right and center, another nurse stitching up a mother who had just delivered, a wailing baby crying on the receiver and of course this woman laboring away,screaming away the last and longest stretch. Oh and there was blood.......and other stuff! I caught a glance of her face and all I could see was confusion, pain, terror, anxiety and was that a fleeting look of shame? After a lot of "prodding" and pushing, she welcomed a bouncing baby into the world and we all sighed, some in fear, others in awe, a lot of us in disbelief but the more seasoned fellows looked happy, it was over and the little one shrieked away pinker than pink panther with a full head of hair!

I don't remember leaving the room, I don't even remember what I did after that. But I remember that woman lying there, astride, her womanhood splayed open in front of how many eyes? Students who just came to "see" what birth is all about. Like watching a movie. I remember the not so friendly midwife, hurling orders, clearing  the way, holding ominous looking scissors. I remember the look of terror, of pain and of shame on the woman giving birth to her precious baby, I remember how undignified she must have felt, I remember how vulnerable she must have felt, I remember how exposed her womanhood was, I remember how disrespected she must have felt to have all our eyes on her, I remember the look of anguish she had, I remember her trying to cover up herself.....

So today, I want  to remember to respect a woman in labour. I want to remember to cover up a woman at this very special moment. I want to remember to encourage this woman. I want to remember to give her privacy. I want to remember to allow her to enjoy birthing, I want to remember to allow her to deliver her baby in the most comfortable position, I want to remember to allow her partner to share this moment, I want to remember to be gentle, I want to remember to wait for the little one to make its way out, I want to remember to give her her dignity back, I want to remember my hand on her shoulder, urging her on, I want to remember receiving the baby in my hands but most of all I want to remember to smile with her when its all done!

Of babies, nether regions and sex

So this issue has been brewing in my mind for a long time now.....in my line of duty, I see a lot of nether regions, ALOT! And we are all different, it's actually amazing, kinda like the way we all have different facial features. There's abit of variation between those who have delivered naturally and the first timers. The best part being that the experienced ones are usually more willing to work with us as we bring the new life forth.

From my study of the human body, the birth canal has very strong muscles which also have the highest tensile strength. A baby's head passes right through it and it goes back to its original state. Since time immemorial women have done this, and men with their women have continually Engaged in intercourse and produced even more babies. Rumour has it that the sex actually gets better, you know, the more the muscle is exercised, the stronger it gets and the more it contracts end result PURE UNADULTERATED PLEASURE!

However, There's a trend in town that women are chickening out from natural birth so As not to 'ruin' the nether areas....so my question today is actually very simple, and I want all to have an input, men and women alike.... Is there a difference in the sex after natural childbirth?

OF A SPECIAL BOY

So two years ago today, I was a patient. I had been admitted at exactly thirty eight weeks for an elective Cesarean section. Woke up very early in the morning, my c/s was scheduled for midday and since I really don't love hospitals I promised my doc that I would be there very early. My hubby drove us there and we went through the rigorous boring process of admission. Now I was really not amused to be on the receiving end of the medical personnel. First, the labour ward was so busy, the place was just crawling with women, some looking more pregnant than I was. I was tossed into a waiting room to await admission or was it a free bed? For some reason, I didn't look like I needed urgent attention because it took us over two hours to get the basic vital signs taken, someone to listen to my little man's heartbeat deep inside my belly and eventually get a gown and a bed! Now we medics are the worst patients and you can imagine that I had started thinking the worst, like maybe there's a cord choking him and no one cares....my BP is rising and these people are not bothered...terrible!

So eventually I got settled in, even wore that gown that is open behind...(why is it even called a gown really????) and waited for my midday appointment(....with anesthesia....what if I wouldn't wake up, what if the anesthetist pushed the tube down the wrong pipe? what if I bled uncontrollably? DAMMIT). My sis and pals were there too, I guess for comfort but am sure they were more interested in the little life that was about to pop. Hubby threw in a comment of how ObsGyn would be an ideal speciality to pursue, I looked at him like SERIOUSLY??? I can't do that? Its too bloody, too messy, too painful every excuse I had in my brain. By the time Midday arrived, he had even drawn up my study timetable for those three months I would be home for maternity leave, an Old Currents Text Book which had been handed down through his family reappeared and let's just say that battle I lost!

So my flamboyant Obstetrician arrived, in full pomp, dressed to kill as always and announced to me that she was very sorry, theatre was occupied with emergencies and her midday slot had been taken by someone. The best she could do for me was schedule me for 7pm that night. Ordinarily that should have been understandable, but tell that to a term pregnant woman and its not the same. I waaaaaaaaaaaaaaaailllllllled!!!Wololo! (Yes I will blame it on the hormones)! OK, this particular pregnancy had been difficult. I remember I used to throw up even at the slightest smell of even water! SERIOUSLY! I remember working at the clinic and some women would come wearing designer perfumes(I sincerely hope they were though) and the moment she would enter my cubicle I would rush to the loo to throw up! and this was at the seventh month! Secondly, the little man inside of me would give me such intense hunger pangs that I actually used to get tremors. I actually walked away on patients in the consultation room to go get a bite. Thirdly, my tummy grew so huge so fast I got so tired of people asking me "you've not yet delivered?" Damn them! Fourth, I had a backache from beginning to the end, add the over sized belly to the equation and disaster! As for my Sex life.................(no words)! So, I was really tired, I wanted him out yesterday! and now, my appointment pushed to 7hours later, torrential downpour!

So at exactly 7pm, I was wheeled to theatre and my son was delivered. a Healthy baby boy, with a perfect APGAR score( I think this is the one and only question I asked when I came out of the deathly throes of anesthesia, ) Two years down the road, he brings us so much joy! He wakes up with a smile, he hugs me all the time, he obsesses over his sister like a brother should , he looks up to his father and tries to fit in his shoes...literally, he feeds so well, he tumbles and falls all over everything! His little mouth is full of teeth, of late, he has started throwing tantrums all over..terrible two at the peak! He has the cutest smile ever, little arms that hug so tightly and he now has a huge vocabulary of words, sometimes he says very funny things we keel over in laughter!

Two years down, am an ObGyn in the making. Loving every moment of this wonderful journey, and trying hard to always think of my patient as myself. Happy Birthday Baby G, I think it's time we dropped the baby and just said Happy Birthday G!

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>

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!