It is so absurd that in our environment all that any young couple thinks about is procreation. And so came this day that I had two old patients that I once banned from seeing me. The first was a young lady I had performed a caesarian section on about eight years ago. She had represented with another pregnancy at 3 weeks forregistration. After that we never saw-her again ntil she Was in labour. I had instructed her to send for the husband so that.I can explain to him the implication of poorly supervised ante natal period and the way forward. She left again and only came back when she thought I had gone. And when she discovered that I was still waiting; she exclaimed aha doctor are you still around? I said yes and when I saw that her husband was not with her, I went home.
The next day was Sunday and while the waiting game continued, the husband was not even reachable by phone. The line as the networks would remind you were switched off. And by three in the afternoon he suddenly appeared with two gentlemen who called themselves pastors. Their mission was to stand as guarantors for the payment of the surgery that has not even been decided on! I did not know how to respond to this. I simply took the patient together with the pastors and her husband to the scan room. By this time the baby was already dead and the uterus was ruptured. One suddenly realized that it had taken eight years to come this far and loose the baby out of callousness. She made it through surgery and now desperate for another pregnancy.
The second story again was not so palatable because it ended up in violence. She was not even a registered patient of the hospital. The medical of-ficer had given me a call that they had a patient with abruption placenta. This is a situation where the placenta separates from endometrium, the inner covering f the womb. This leads to bleeding behind the placenta, a condition referred to retro placental haemorrhage.
The major problem with abruption placenta is the consumption of fibrinogen, a clotting factor which leads to clotting failure or disseminated consumption coagulopathy. This is a care-giver's nightmare because this is a sure death. So when I was informed of the situation, I had ordered that three litres of fresh blood be transfused empirically before delivering the baby; best through the vagina or dreaded surgery. This is the current way of mapaging abruption. This was not ,done, and when torrential bleedirig started; there was nothing anyone could do. She passed on We Were tatel to learn that the baby had been' dead in the womb for aboUt two weeks before presentation! The relations became very violent and started destroying hospital properties! Their anger was that nothing was done after inviting the surgeon who apparently knew that it was a hopeless case. Law enforcement agents saved the day. There are so many incidences like these that give the care giver the blues. Lately a lot of practitioners would have noticed that some women would have their antenatal supervision in one facility and when she is assured that everything is in order, she disappears and have her baby elsewhere. They only come back when there is a complica-tion. The irony in this, is that they don't even go to a better equipped health facility be it government or private; but to where the woman of God delivers babies without operation! And then sometimes find them coming back in the dead of night with severely compromised clinical condition.
We may be going through difficult times in terms of economic recession. Unfottunately these places they go to are all fee paying in whatever designation they might want to accord it. So honestly finance may:not be the challenge in most cases. I had a friend whose wife had fibroid and got pregnant with it. I was so concerned that every time she came around I had to do an ultrasound scan to monitor the migration of the tumor as the lower seginent of the uterus developed with increasing size of the baby. This was at no extra cost. Then on their last visit before her confinement, after scanning the wife, my friend asked me seven times: "Dr. you said everything is OK?" I told him that for now I can't envisage any problems. He turned to the wife and repeated it.
After that I never saw them again until one day he came to tell my staff that the wife had delivered without operation. My staff of cause told him that I would be displeased. He had taken our friendship for granted and boasted that "he will understand." So as he was passing by one day, he branched to see me. I was so angry that I didn't even allow him to say a word. I walked him out of my office and as he left he banged my door. I guess that ended our friendship. It so happened that one year later he came with a religious sect and pointed to my facility. They started singing and praying or rather raining curses. I was curious and had to find out why this should be. I was informed that after one year the child couldn't sit down. He has CEREBRAL PALSY, an irreversible damage to an immature brain. Apparently the baby must have suffered severe birth asphyxia due to difficult delivery with poor resuscitation or badly managed neonatal jaundice. There is so much superstition in obstetrics that we all need a rethink.
......yes, Goodnight Sir Stephen Olayinka Adekoya
I had once written a piece in this column with the title, 'just before good night'. The 1st of July was the day for the requiem mass for my Egbon at Arch angels' parish in Satellite town, Lagos. It was a working day, yet the church was filled to capacity. There weren't enough seats in the altar for the priests that came. Adekoya was one man you wonder whether he ever gotangry. The smile was always there. He spent most times greeting people and making peace. He even wanted me to join the knighthood. I politely told him that I Wasn't, good enough because of my , odd hours and deadlines as a surgeon and a writer. During the sermon, the priest said: "You all should live your lives like this man, so on a day like this, we priests would not be forced to lie." Now hear this from his son: "My father saw it coming and was ready." Words engraved in marble and gold.
Good Knight SIR!
By: Dr. Emmanuel Enabulele
Daily Sun News
ABUJA: Training Schedule for Basic Life Support BLS, Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support ACLS, First Aid, CPR, AED
PORTHARCOURT: Training Schedule for Basic Life Support BLS, Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support ACLS, First Aid, CPR, AED
LAGOS: Training Schedule for Basic Life Support BLS, Pediatric Advanced Life Support (PALS), Advanced Cardiovascular Life Support ACLS, First Aid, CPR, AED
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