exodus

Internship is an exodus whose chronicles should just remain that ,chronicles

My first 72hr weekend call is what marked my first baptism.You see,I went into internship with a great zeal ,to learn ,practice and perfect all that apertains my profession.Isn't this what they tell us when we graduate? I still remember my last lecture in medical school ,medical ethics and empathy for the suffering. This was a parting shot for me and as such I felt it was the summary to the 6 years.The same way Christ upheld love is the same way I said ,above all show empathy.

Anyway this particular weekend was full, I mean ,to the brim. It began with a call from the medical ward with a patient treated for severe malaria. The patient had worsened with blood sugars fluctuating, respiratory distress ,deranged uecs and a reduced level of consciousness. Yes ,I still perfectly remember with terrible exactness. I remember murmuring to myself what next in a limited system. No man is an island ,so I called my second on call and the feedback was something I didn't expect ,I was on my own. Am I remember is walking out of the ward . The sun was pretty young. I leaned along the wall ,letting the rays caress my feeble exhausted self. Thinking deeply ,deeper about nothing. I let my eyes follow the rays and admired the sight. Afew minutes later I'm call to certify the patient. I must confess I have never forgotten her face and how she had looked at me expectantly.This was my first loss and I remember gathering strength to see other patients.

Fifteen minutes later ,I get acall from maternity , two women with obstructed labour and a fetal distress. I request a full haemogram and I was informed the machine had broken down. We sent out samples and the agony of the wait time began. My teaching was an emergency should be sorted immediately. The wait exercebated my anxiety ,at this point I thought I wouldn't live through another mortality. I have never prayer that much in my life. I lost count of the number of fetal heart rates I recorded, the number of times I ressured the mothers.Full haemograms came back 4 hours later. All along I was at the maternity ward ,waiting and making numerous calls. By the Time I got them back ,its 4 pm ,no breakfast no lunch ,no shower. Unfortunately their haemograms for some reason all had low hbs. It wasn't a good time to question reliability ,they already act as evidence in case things went south. My first plan of action was to refer the patients to the next facility because we didn't have blood. I call my second on call to inform them of the new development. Shockingly they thought I couldn't think on the side of the patient. In her/his wildest dream i should have thought of a possibility of an ambulance coming towards our facility and request them to get blood instead of us referring. Magical as it sounds. Our next referal Centre was 2 hours away. How is it possible that at that particular minute and second there was an ambulance driving towards us. There had been no referrals from us. I was dumbfounded. The exhaustion of the mothers and their hope instantly killed me. I couldn't fight back my tears. To cut the long story short we did the caesarians at midnight ,and the babies scored.And this marks my first miracle .

To the forests we belong

I swear ,I have never been as emotional as this particular day.At least I can remember any instances of elevated emotions ,but even then I managed to ground them. Days come and go ,even those we have so longed for and never let them go. Every dawn brings with it a tide ,one we have no control with but to swim along to whatever pole it takes us to. Just so you know ,I'm a believer of fate .We can argue out the control and lack  thereof whoever wins ,its never that serious ,every monkey has its tree ,its not a litmus paper to anything ,not any monetary thing i know of.However we can't ignore the fact that some monkeys have an entire forest ,and on this I'm very opinionated. You argue with me I shoot you ,you argue again I shoot right through your SA node. 2020 came with a new conversion. The cult we all should convert to.Whether you got a withering tree to live ,a forest or no tree at all you got to accept.I mean you only got 365 and a quarter days ,I have never seen the quarter BTW ,but we can't afford any negative energy. On this particular day I was discharging one baby ,a year old who had been managed for severe acute malnutrition. She had become the highlights of my last 25 days. I remember when the entire world remarked the birth of Christ ,I was by her bed side, it didn't make sense to merry while she had a desert to her side. She had grown fond of me and every time I entered her cube she would smile ,stretch her emaciated weak upper limbs towards me and I would carry her. It reminded me of my childhood ,how we would wait for my dad by the backyard especially when my mum wanted to instil some discipline in us ,when one person spotted him ,we would all roar into a chant , off in neck breaking speeds and throw our tiny bodies over him. If you cant relate kindly remind me i am growing old. For the record ,no one ever needed a cervical collar for a broken neck. Carrying this baby every morning inspired my early rise. I watched as life came back slowly to her . She regained reciprocal social behavior and soon she was fit for discharge. The morning I wrote her discharge I felt devastated ,I was heartbroken and I didn't want to let her go. I was worried she would come back malnourished. A blanket sign from her mother pointed to a tough life. Did not understand any Swahili , tall tiny woman dressed in tattered clothes. Seven other kids at home. She was shy ,smiled with her eyes peering on the floor. When your eyes got in contact with hers, she developed instant nystagmus  and all I read were hidden pains. She however was content. You remember the forests up there? .This is not a question of whether fate is fair or not. If we all could be as content as this woman ,this world would be a better place. I mean ,you pick up your struggle ,drag it ,pull or roll it and move on. You comment on your neighbours struggle ,we hunt you down.You throw some tantrum hatred we combine it multiply by an infinity and send the damn thing back to you. You amasse anything that aint yours ,you return to us sevenfold to the seventh generation,until everyone minds their forests.The day we realize the adage ,grass is greener on the other side ,is a microscopic view of life we live. We can't be running after some greens even when we are 100 and gasping. If we have or we don't ,let whatever is be ,we can't have all. We can't be everything we would like. This beats humanity. We wake up ,we till what life has offered ,we sleep whether it is on a hammock, animal skin or on a bed ,the REM and non R EM sleep pattern is constant. Whatever brings happiness ,chase thee it. A friend once told me she would walk into her husband's house with a rag she had kept for days ,and I was like ,if this rag bringeth thee joy ,then may it be. I'm still to ascertain if she still owns it .LOL. Every monkey to it's forest ,as they say.

Undeserved

She came in on a stretcher ,wheeled by two elderly women. I still remember vividly ,Saturday 11:07 ,it was. I was covering for the weekend call  and this time round luck had been poured in plenty.Friday was smooth ,events not very alarming and by 2am I was dragging my exhausted body to asleep. No more eventful events. At least. A call came in at 8am ,that we were expecting a referral. 3 hours later ,I'm standing at the right side of her stretcher.She was confused ,I couldn't tell the colour of her clothes. Pungent smell filled the house and before I knew it ,I felt my head 'revolving' as they call it. She had multiple layers of metal bracelets on her wrist and ankles and necklaces and I remember wondering if she wakes people at night from the noise .She was semiconscious and she looked as if she had taken a bath with mud. Literally. Eclampsia ,read the diagnosis from the referral note.She had been referred  to 3 hospitals before arriving. All miles apart with no proper means of transport.Once she stabilised ,we rushed in for an emergency ceaserian.Unfortunately her baby had longed died. 10 days later she fully recovered and on the 11th I couldn't resist to take another social history. 17 years ,married off ,lives in a neighbouring country near the boarders. At the end of the interview all I could mumble is how God loves this woman ,days of labour at home ,convulsions and days later ending  in the hospital,at the butchers table ,and walking out of all this. If you ever think this is purely luck ,it would take an eternity to halfway convince me

Silenced innocence

If you ever thought you are fighting too hard to be alive ,trust me you aren't. There is always someone worse than us and still satisfied with what they have. After all ,what is life ? Presence of cardiopulmonary activity period. If it ceases we all die ,one death. What is the pride for ? Whether you are buried on a golden casket ,wooden or in your natural suit ,it never reverses the rigor mortis.Those of us who still need a bed , shoes ,clothes ,I can swear are living a luxury . If you ever managed an edication ,you are in paradise ,atleast according to some standards .There are people who have nests to call home and you got no right to think that now that you live in some posh estate your house got more rights to be called a home. We all wake up to the same sun ,we all got 24 hrs a day irrespective of what we do with them. I met her during one of my rather slow days.Someone had made a diagnosis of hematocolpos and to me this remained in the confines of medical books,one of the differentials you give when you are about to score a distinction,that is if you ever remember. And this was/is only for the chosen few ,the outliers of the normal curve coz medical school is survival from day one.Baptism is only by fire and sulphur smoke ,nothing less   At barely 11 years you expected a look of innocence .She didn't disappoint ,all I saw at a glance was a soul,beautiful ,probably enjoying her childhood were it not for a disease process. Little did I know what lay behind that strong face.I couldn't believe someone at this age would have undergone an extensive FGM.School in a halt and probably a homohabilis of a husband in waiting ,dowry already paid without consent. Who says you have to consent to anything as a woman? Recently i watched a document on the Trokosi girls , raped ,married off to gasping old men with rigor mortis setting in ,enslaved for sins they didnt commit At first I thought I saw a SUMI scar ,atleast I was sure. Amidst shock and fighting tears i asked her who the barbaric surgeon was ,and when she mentioned her grandmother i felt devastated. Our grandmas are an equivalent of our mothers. We all think they want the best for us and would never hurt us. I m sure when she was told she would be beautiful in the tribe ,a woman ,she didn't hesitate to bear the pain.I felt guilty ,of ever complaining about things in my life others would consider blessings, of ever thinking even for a second that I was unfortunate. And to the people who are at the forefront of this barbaric practice ,I never cease to wish the worst to you ,if you are still stuck at the idea that women should never enjoy sexual experiences or whatever reason you hold for this ,I bet you deserve some two nails ,6 inches through your occiput. Perhaps then you could see light ,even flashes. We are human with a half-life of 70 years ,let's embrace everyone ,show some kindness for we shall pass through this world only once.

Internist diary

It's a rather slow Monday morning. One of those you keep glancing at you watch, fidget on your phone compounded by yawning. I have been through a  busy 60 hour weekend call and I only got  to lay my head down for 15 minutes. I'm unproductive and highly irritable ,asking myself severally why internship had to be baptism by fire. Amidst my efforts to convince myself  I was still strong enough to take in some more  ,I remember I needed to prepare a theatre  list. It's our clinic day, and as usual patients are already lined up waiting patiently. It's only 7:49 am. I cursed between my breaths.My stomach is now rumbling. In the last 48 hours, I haven't had time to sit and eat well. I have been surviving on bread and soda, once in a while diversifying on the soda. While I'm still lost in my thoughts, two calls come for emergency reviews. Lately I have grown my hate for the phrase 'Daktari patient has changed condition and complicated, kuja review '.What is to change condition and complicate?. First of all this is a 92 year old with, hypertension, Dmr, heart failure  and COPD. If you know you know. Nimeachia hapo. The next patient is an acute intestinal obstruction. I get to the ward to find the  'complicating patient ' ,lying on bed just as they were admitted. She looks anxious, dehydrated and in pain.  Asking why the patient is not on fluids just broke my heart. 'Doc patient hana line? '.Did I mention I was already irritable? I didn't speak. I get an iv access, that took me close to 30 minutes. What else can you do when your veins are collapsed. I get in an NGT, catheter, take samples for  urgent lab works and request the nurse to put up fluids for her. I need to  get to the lab and get the results back before calling my seniors . Seniors are only called  when the  patient is  thirteen seconds from anaesthesia administration. It's 10:15 am I pass by theatre to let them know the emergency patient is  coming in. The theatre nurse asks  how it takes you  one hour to get the patient in theatre. To cut the long story short, the patient is finally in theatre at 10:40 am. At  11 am, I'm scrubbed in , on the left to be precise, armed with a retractor and  suction.once the abdomen is opened ,percussion begins. The surgeon points at structures drowned in blood and the famous question begins, 'what artery is this '.First of all my mind feels like it is under siege. I'm struggling to remember if oesophagus is the windpipe or vice versa. 4 hours later we are done  .Patients are still waiting for us in the clinic. It's 3:30pm ,I conclude  what doesn't kill you makes you stronger. Tomorrow is another day, we will live to fight again. At 6pm clinic is done and just as we are closing, an emergency is rushed in. It is an osteosarcoma of the skull. Bleeding profusely with maggots in and out of the skull.. I must admit I had never seen anything like it. I'm scared, the patient is calm, perhaps he is gotten used to this. This is my first time seeing maggots. You have to figure out how to have everything in control .It is called internshit.

Internship chronicles

I definitely have had happy moments but nothing compares to the night I completed my end of medical school exams. The days that followed  were filled with mixed reactions, I have spent almost half my productive years in school pursuing a single degree while my social expectations were still unmet. We all know the traditional family, career with three dogs ideal scenario. Anyway I packed my little belongings  and headed for my internship, armed with a Hippocratic oath on one hand  ,a licence on the other and a stethoscope dangling from my neck, all set to relieve suffering from humanity. One thing I must confess I feared was the popular calls ,one, because my love for sleep comes second after God, and second I had heard harrowing stories about them. There came my first call and here I was set to be circumcised into the profession.  I had been ambulating from 7am  in the paedriatric department trying to fix cannulas  for aggressive children who obviously  didn't like my presence. Time moved fast and before I knew it, it was clocking 5pm and I hadn't had my planned prophylactic one hour sleep. I sighed as I examined my last patient, and as I headed for the exit my phone rang. It's 5.07 pm. 'Daktari there is a patient in the male ward who needs a review 'says the caller. I headed straight  to the male ward to find an aggressive well-built patient  and a mean nurse. All my tired brain could offer was a flashback of the lecture on an approach to an aggressive patient, no details whatsoever. Whatever I did is a story for another day. I'm called for two more resuscitation, the nurse demands I fix 6 more lines for some new admissions and by the time I catch my breathe it is 10 pm. I'm super tired ,exhausted and hungry .I head to my house and even before I could switch on my lights my phone rings, this time it is maternity calling. They have 5 patients I have to review, 2 are fetal distresses. I'm already in distress. I take a glass of juice and head back to the hospital. The last time I read obstetrics was 3 Years ago all I could remember was something called Leopold's maneuver  .Whatever the maneuver was  for is something beyond my cauda equina  .In my mind  I'm wondering who invented it, was it the great King Leopold's 1 or 2 of Congo. Before I settle on the answer, I'm already at the maternity ward. Cries of pain  mixed with baby  cries rent the air perhaps reassuring them of the China debts  that  awaited them. I'm handed  7 files. All the maternity nurses are talking at once. 'Daktari hawa watatu tupeleke CS hawawezipush the rest  utuambie tufanye nini '. I'm confused . On doing the VEs I'm more confused. Kwanza I cannot tell what anatomy my hands are feeling  .Everything feels fleshy. I remove my gloves and decide  the mothers will have cervical dilatations of 3, 4, 6 and 8 from the youngest to the oldest. By now I'm operating on the bora uhai slogan. Listening to their FHR convinced me that I must have maternity induced hearing loss or just wax maybe. I give up and decided all the mothers had fetal distress. End of story. Prepare for emergency CS  I indicate on their files. It's 1 am, I call my second on call who laughs at my diagnosis and tells me to repeat my obstetric examination in  the next 30 minutes. Now I have to decide on what their next cervical dilatation and FHRs will be. To cut the long story short, we ended up doing 3 caeserians that night. By the time we finish it is 5.17 am. 4 more calls come from the OPD. The last one is at 7 :15 am , a snake bite. I couldnt understand what the patient was describing, but he kept pointing at his bite wound and back at a black plastic bag .Im too tired to  look for a translator.As I continued scribbling on the prescription sheet, the man gets up picks his plastic bag and without warning spills it contents. Lo and behold  there lies a large snake. I get flushes  ,chills ,pins, needles and fevers.My heart is pacing and in one second, I flew for the door leaving behind a bewildered patient. I couldn't ascertain the cardiopulmonary status of the snake, we all can guess what it was, dead off course, but I swear I saw it's tail wiggle. It was time to flee for my life

Lately, I have grown out of favour for the male female equity and equality discussions ,thanks to the emotional sensation  surrounding the whole issue. Feminism is as toxic as chauvinism. We may never agree on how far is far when crossing the boundaries to either, but then, no man ever wants to marry another man nor a woman another woman .Anyway, this is a discussion of the day. For the past few months, I have been getting used to hearing harrowing tales of women going through circumstances I consider unfortunate. Yesterday, I met this  barely 16 year old  in the maternity  ward. She wore a defeated demeanor, barely  keeping eye contact  .She kept fidgeting with her fingers  and attempted to construct a few kiswahili responses to questions asked. Her hair was gathered in three bundles and from the look, it has taken probably a year or so since a drop of water made an intimate contact. She wore an Old Jubilee T-shirt, red in colour, with an oversized multicolored skirt. No shoes covered her feet and the cracks on her sole extending almost to her knees could hide a twenty shilling coin. Asking her about her parity, I was shocked at the answer, para 3 !And she had spontaneous vertex deliveries, I was perplexed. I vividly remember my first day in the delivery room, about 5years ago, those days when I dreamt bigger dreams .I mean, if you asked me my long-term plans, I wouldn't hesitate to say I wanted to be a neurosurgeon with subspecialization in the basal ganglia a minor in the limbic system with a major in cardiothoracic surgery. The days I was filled with vigour. I even remember telling a friend I wanted ten kids, a rich husband and  a bungalow somewhere in Washington DC! Anyway, fast-forward, I have graduated  to the bora uhai team and the rest is history. Whatever happened to my dream is a story for another day. Anyway ,back to the delivery room, I found ten women, each on a couch in extreme pain. Somehow, my grandma had convinced me that children were bought in the supermarket .Even though I had obviously outgrown her version of procreation, thanks to biology, for some reason I didn't know the pain at giving birth was that much. And the accompanying bleeding wasn't anything close to my expectations. From that day I vowed never to pursue obstetrics at least if not for the PTSD, then for my hate for periniums. But, this 16 year old delivered her baby almost effortlessly. She had undergone FGM and a generous episiotomy had been administered  .I saw neither a tear nor a wink .Nothing prepared me for the shock I got when I met the husband. He was a homoerectus of a man, probably this was his fourth wife, and he felt no shame being a husband to a teenager.For a moment I thought I had met my ancestor.He wore dirty clothes Honestly ,this  girl was supposed to be somewhere in highschool with girls of her age discussing crush celebrities not cooking for some great grandfather with emaciated kids. On the second day, she still hadn't had her bath. Nauseating Smell of lochia with a bunch of flies were her portion. Reason, until her husband licensed her to. First of all, who ever thought they needed permission to do basic things as washing up. Even the hygiene status of the licencer himself was something to feel sorry about. He must have taken his bath during the days of the great Kimnyolei. The day he came to me demanding a discharge for his jaundiced  baby, I fled in a terrific speed .I have never ran like that btw.Infact ,the next day  my feet were sore from the rapid flexion and extension. I couldn't understand what he was saying, but the tone and the look he gave me told me it was time to flee for my life.  Ever heard of the blind leading the blind ?this was it!