THE LOCUM DIARIES (29)

Day 29…

I got to the bus stop and again there was no vehicle! ‘Which kain meeting these people dey get?’ I wondered. I was running late for work. After waiting some more minutes with no ‘keke’ in view, I started hailing ‘okadas’.

‘Pako how much’ I asked one, ‘200 Naira’ he replied, ‘Na pako I talk o, no be pakoto’ I said and moved away. I kept stopping bikes till I stopped one that took me to pako for 100 Naira.

Lagos Okadas, Wilding!

I got to work and after exchanging pleasantries with the rest of the staff, I went into my office. I spent the 1^st 1 hour listening to radio (as usual) after which I proceeded to working on some outstanding assignments. Oga was not around (you will know Oga is not around when you see all the female staff sat at the reception area, watching African Magic, Telemundo or Zeeworld, I think they even have a timetable for it). I was in my office when a patient came in, nothing unusual, the regular fever, headache ,body pain (i’m sure you can rattle the remaining complaints by now,clap for yasef). I sent him to run a few tests.While he was at it, I continued my work, all of a sudden, the front desk lady ran into my office, ‘Emergency, Emergency!you need to leave everything you are doing and come out and assess’ (all these people know how to fear somebody aswear!). As I was coming out, I was vexing, ‘wetin be this emergency thing wey dey always happen anytime I dey around? Shey na set-up be this?’ I thought as I came out, I went to the hospital premises where a bus was packed and people gathered, all panicking. I tried to be calm (that I think is the number one rule for any doctor, be calm, don’t rush, even if you don’t know jack, calm down, something will come…hopefully). ‘Wetin happen’ I asked, one of them who happened to be his colleague at work explained how the man, a hausa truck driver was hit by a ‘danfo bus’ going ‘one-way’ as he was coming back from the mosque. I went over to where the man was, in my mind I was panicking ‘I don enter wahala, road traffic accident, how I wan take run this one like this’. I looked around, thankfully I wasn’t alone, a nurse was beside me (at least if I fam, person go fit dey as backup). As I was checking the man out, one of the guys said ‘Doctor, you no go carry something come check the man? E be like say you no know wetin you wan do’, At that instant, ‘isi mu gbaka!’ Meaning ‘my head scattered!’(saying it in Igbo expresses exactly how I felt). Ladies & gentlemen, I gave it to the man o! ‘Do you want to teach me how to do my job? Please if you cannot be calm, please leave!’ (I think I said more than that, but you get). The others begged me to ignore him. I called the man by his name, ‘Can you hear me?’, he opened his eyes and responded clearly. I was relieved. I tried to assess his mental state, he responded positively and he told me what happened and the places that were affected; his right arm and right side of his body. Now next thing, what do we do for him? I came inside the hospital and consulted with the nurses, trying to draw a plan for him. ‘He needs to immediately run a Head CT, Chest XR, Abdpelvic USS, Humeral XR’ we agreed on this; we also agreed that he will need analgesics, the bone of contention now became, ‘should we admit him or not?’ Some of the nurses felt we should admit him 1^st, at least to commence treatment on him before he goes for the tests, I felt that because of his condition, too much movement won’t be good for him and as such, he should go do the tests, so we can know exactly what we’re dealing with, if its something we can handle we admit, if not we refer. They saw the sense in what I said and we agreed with that move, as we were about to proceed, NEPA struck! The light went off. Now there was a new argument, should we go put on the gen before admitting the man or bring in the man before putting on the gen? and the nurses went back & forth (both in words & movements), at some point, I had to tell one to go sort out the gen while the others go outside to bring in the patient. As they all dispersed, I went into my office to write the tests they will do, but before I started, I started processing ‘ATLS’ *in Enweluzor’s voice in my head, I guess because of the panic & adrenaline, my head was jammed, I quickly brought out my ‘surgery guide’ and began to scan its pages, trying to make sure I didn’t miss out on anything. Thankfully I did most of the steps and the ones I wasn’t sure of, I went back to the man to confirm. I came back in and in the middle of filling the tests form, I heard noises at the reception, I ran out, an argument was going on between one of the nurses and one of the colleagues of the patient, ‘we cannot admit him until you have opened a file and deposited’ she said, the man responded ‘We are talking about life here! Do you know the company we work for? Money is not our problem, just admit the man and we will be sorting that out’. She refused, insisting on pay before admission, the men were clearly angry and started making calls to their superior and informing them of the development. ‘We do things with protocol’ they said, ‘you can see it’s already night, they cannot process the money till tomorrow morning’, the Nurse didn’t bulge. Me I was just standing there watching ‘cinema’, the back & forth and confused, in the middle of the calling, one of them wanted to give me the phone to talk to their boss, I refused. ‘is nor me that will be scapegoat’ I said as I directed him to the nurse. At some point, I had to call all the men to one side and as they were venting, I had to calm them down and make them understand that it is hospital policy and that no one wants to lose their jobs. I suggested that someone uses his personal money to pay for the treatment to commence while they sort out the processes tomorrow. They agreed and made more phone calls, and after some minutes went to the front desk to get the account number. As that was going on, I went over to the front desk, ‘are we sure this test people will still be open by now?’ I asked. No one was sure so we decided to put a call through to the center. Several calls and no one picked. ‘its most likely they have closed’ I said, ‘Lets admit and start something, they will go do the test tomorrow. Hopefully there’s no serious internal issues with the man’. The man was brought in and as he was taken up, I rushed back to the office to fill in the history based on all I had asked them earlier and include the treatment modality for the patient. After that, I sprinted upstairs and as I got to the nurses station, I met Oga, ‘what have you done so far for him?’ he asked, I briefed him. ‘What are his vitals?’ he asked, ‘shet!’ we hadn’t checked! I thought, ‘Sir, so far his temperature is normal, his BP is normal, airway clear’ and then I diverted,’we will set a line for him and give him painkillers’. As I said this, I ran back downstairs into my office, ‘maybe they checked and I didn’t know’ I said in my mind as I checked his vitals section on the computer. The nurses didn’t check. As I was about to go back upstairs, the patient I had seen earlier, the one I sent for tests came in, I quickly checked his results and prescribed drugs. I went back upstairs, to the room where the man had been taken into.Oga was trying to check the BP, I assisted him with that (it kept reading error), Oga left for his office and I and the nurse stabilized the man and gave him all the drugs. I checked the BP again, 208/186! ‘Is my eyes paining me?’I said in my mind as I looked at the reading closely. It was same. I went to Oga’s office, I informed Oga of the readings, he confirmed it with a previous reading one of the nurses got. ‘What are the signs of increased intracranial pressure?’ he asked , ‘Oh nooooo! Not now sir naaaa, can’t you see all the stress I am going through, have some mercy’ I said in my mind as I steadied myself to deliver the answer. ‘Headache, Raise BP, funny breath sounds, errrm, errrm’ I stuttered. ‘Go and check the pupils’ he said. As I went upstairs, I brought out my phone and searched ‘Signs of raised intracranial pressure’. Luckily for me, network was kind to me and the answers came up, ‘Headache, Nausea, Vomiting, PUPILS NOT RESPONSIVE TO LIGHT, high BP…’ I moved swiftly into his room and checked, his pupils weren’t responding. I checked again and again, it didn’t respond. I went back to Oga’s office and informed him. He immediately left his office and we went to the patients room, he checked, same result. He then checked the pulse (when I checked it, it was bounding), he started nodding and smiling at me, I didn’t exactly know why he was nodding or smiling, was he confirming my suspicions or confirming my ‘balls’? anyway, I responded in similar fashion as we left the room. As we went downstairs, I didn’t have check the time, I knew I was so late! I bade Oga goodnight and zoomed out of the hospital. ‘Hopefully, I don’t get home in the morning’