For long I had wanted to write about this, but whenever I tried to hit my keypad, my fingers got cramped. I guess it was the incredible nature of this discuss that slowed me down.
Lately, I was invited by a colleague to perform an appendectomy on a young man. Had chastised him because I knew he had done quite a few of them unassisted. He didn’t have to bother me. But he insisted I came over.
It was a complicated appendicitis we had to deal with. The appendix was already walled off by loops of small intestine and the omentum.
There was a huge pus collection within this appendix mass.
Here we did the safest thing possible. We didn’t bother looking for the appendix to remove it but just created openings for pus and other peritoneal fluid to drain. After the procedure came the high fever, which obviously was as a result of infection now due to mixed organisms; both aerobic and anaerobic, gram positive and negative bacteria. When you come to this pass, you just throw in the strongest antibiotics in your arsenal. The fever persisted. As we were waiting for the blood culture result, the patient became very pale and weak; the blood count had dropped to a PCV of 15 per cent. Practically to raise the PCV to 30 per cent, he would need five pints of blood. By the time the second pint was half way, he had serious blood transfusion reaction. It had to be stopped.
On the fourth post-operative day, there was copious leakage of faecal matter from the wound site. He had a high output faecal fistula.
Simply put, he was having diarrhoea from the fistula opening. The challenges were now multiple vis-à-vis sepsis, anaemia and dehydration. It was time to talk to the relations about the way forward and possible referral to a facility for total parenteral nutrition. But wait for the response: “Dr. you people have tried and we appreciate your efforts. We know what is happening. The challenge we have now is where to find the money to buy a white ram to exchange his head!” It sounded strange to my ears but I must confess that I have heard such things before.
Then he continued: “You see that sore in his left leg?”
“Yes, I thought he was diabetic or had some vascular lesion that
ulcerated when I saw him the first time.”
“Dr. my wife also had the same ulcer and the late senior brother. The
mother belonged to a society where she partook in eating other
members’ siblings. And when asked to bring her children for the feast, she would negotiate and in the interim donate their legs.
Unfortunately, she met her waterloo during one of her escapades. That is the reason she cannot intervene. Ask your nurses; they’d tell you that every night that they would hear the patient pleading with his late mother to intervene, only for her to respond that she is helpless, having crossed over. The truth, doctor, is that I have been advised to stop spending money on him. After him, my wife is next but I know what to do to stop them getting her.”
By this time I have heard enough and in no time the patient gasped and passed on. Bad enough, the sister was trying to blame the hospital for mismanaging the patient. By her reckoning, the surgery was not well performed. She was roundly and angrily rebuked by her husband who apologised profusely. Well, the truth is that a bereaved person is an aggrieved person.
Our second case is even more minded bugging. She was a 26 years old lady,who called herself Queen. She was sent to us by her boss who happened to be a very good friend of mine. Her story was pathetic; he was told that she was going to die because she had no money to operate on her fibroid. Out of empathy, he sent her to us with the assurance that he’ll pay up but installment ally. If I had the resources, I would have done it pro bono because of our friendship. The surgery was relatively easy considering the size of the fibroid, which corresponded to the size of a 24 weeks pregnancy.
The first shocker was that when we enucleated the tumor, we couldn’t see any bowel loop despite being in the peritoneal cavity!
Well, we secured haemostasis and came out. She did very well post-operatively and the wound healed by primary intension. She was with us for eight day after which she asked for the date of discharge. Then I made the mistake of telling her it was the next day. I would have asked her to go on the seventh day post operation if I had followed my instinct.
By the next day, I was called by the sister to see her. The scene I met was an incredible drama of the absurd. It was raining heavily outside and total confusion in the ward. The patient was shouting: “Mummy, they are coming again!” As she said this, she pushed and kicked so ferociously that I was stunned just trying to figure out where the energy and power was coming from in this fragile looking young lady.
As she did this, her mother was also shouting JESUS, JESUS! I was at a loss about what to do. I had to call a friend of mine who is a clergy from the Sabbath church. As he prayed, I noticed that he was shaking his head in frustration. I knew then that the worse is even yet.
Out of fear of exhaustion and possible collapse, we gave her LARGACTIL, a neuroleptic to calm her and send her to sleep. By the next day she had a protruding tongue and tremor. We continued managing her as a case of organic brain syndrome. After three days of this act, I sent her home without warning. She wasn’t done with me yet. After a week at home she came back with collection of fluid in the pelvis, fever and anaemia. We booked her for incision and drainage the next day. While in the theatre to commence the procedure, the hospital manager brought a letter addressed to the sister in charge from the medical director. In it he stated: “Sister, sprinkle the whole hospital with salt water because you have admitted somebody with EVIL SPIRIT.”
She passed on the letter to me and after reading it I suspended the procedure. In clinical practice then, I was a complete rookie in matters like these. I needed to consult.
• To be continued.