Sunday, January 29, 2012

WHAT WOULD YOU DO?



HIV/AIDS


can be a devastating illness.

Tuberculosis (TB)


is equally devastating.

When both conditions are present in the same individual, the effect can be deadly. HIV predisposes to Tuberculosis and TB worsens the outcome of HIV.

That day I first met her in the Emergency room was one I wished I wasn't on duty.
She was a scary sight to behold.
The best word I can use to describe her would be a living corpse. She was a very young lady who may at one time have been a beauty but now she was a bag of bones with a protruding abdomen and thin spidery legs; she looked like a victim of war and starvation.

She cried out for help; I was a little hesitant, concerned for my own safety, but I had to do my job.

COMMON SYMPTOMS OF HIV/AIDS

Fever lasting over a month
Diarrhoea over a month
Weight loss.
Persistent cough
Skin rashes
Oral thrush

COMMON SYMPTOMS OF TUBERCULOSIS

Cough lasting more than 2 weeks
Weight loss
Coughing up blood.

Fast forward to several months later; I was walking within the hospital grounds, when I heard an excited female voice calling out to me, ' Doctor! Doctor!' I turned to see a very beautiful, curvy young lady, well dressed with a smile on her face. She walked up to me excitedly and asked whether I recognised her; I initially didn't, but suddenly I did.






This couldn't possibly be the same lady I almost ran away from treating, the lady with the deadly duo; I couldn't believe my eyes, what a transformation!
But another fleeting thought soon came to mind, what of the next unsuspecting young man that would be entrapped by her beauty?
What should he do? What should she tell him? What would you do?

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Saturday, January 28, 2012

WHEN BLOOD IS NOT ENOUGH


She was brought in half dead.

Indeed, with every minute spent with her, I expected her to give that final gasp and shudder I have come to easily recognise; the gasp of a being who has finally let go of its human form.

She was pale as a sheet, weak, with beads of sweat upon her forehead. You didn't need a magician to tell you she had practically no blood in her.

The normal blood level for a woman should be between 34 - 47%;

hers was 9%

What happens with critically low blood levels?


Blood moves from less important organs like the skin to more vital organs like the brain with gradual system shutdown and eventual death.

Peculiar to this case was the fact that the blood level was initially 10% and became 9% after she had been transfused three times!

Her case was like trying to fill a bucket with thousands of holes at the bottom; no matter how much water you put in, it just won't get full.

SOME VITAL QUESTIONS


What was eating up all the blood? Where was all the blood being transfused going? Why was her blood level going down instead of up?

Those were the questions that needed to be answered. But those questions could not be answered on a dead body; so she needed another transfusion first.

I feared for her life, the clock was ticking. Her veins had started to collapse, they were barely visible; I could only do so much. Would she survive before the blood came? I doubted it.

Fast forward 24 hours, another shift. I checked the ward for her but I couldn't find her, had the worst happened? I braced myself and asked the nurse if she knew what happened to the woman from yesterday. 'Check that room', she replied.

I went in cautiously, not knowing what to expect, but there she was looking bright and able to respond to my greeting. A transformation from the previous day, I was elated.

It was obvious she didn't recognise me; my job was done anyway so I turned to leave as quietly as I came in.

image courtesy

Friday, January 27, 2012

7 THINGS YOUR DOCTOR WON'T SAY (BUT WHICH HE'S THINKING).


You may wonder, what is really going on behind the mask a doctor puts on? Well these are some of the thoughts going through his head:

1. NEVER SEEN YOUR CONDITION BEFORE

Occasionally there is that textbook condition that the doctor has no idea what it is, so you may get a barrage of investigations for that seemingly minor condition.

2. TREATMENT WON'T CURE YOUR CONDITION

The doctor, trying to be optimistic , will not want to tell you that condition is likely to be the start of a lifetime of continuos hospital visits.

3. JUST ROUTINE

You may be very pleased about the doctor's interest in your family and social history but a lot of times such questions are really just routine for the hospital notes.

4.CHANCES OF SURVIVAL ARE SLIM TO NIL

It may at times be better not to ask about the prognosis of a particular condition.

5. NOT SO SERIOUS

Yeah, yeah, you may be screaming your lungs out and you have a swelling as big as a football, but the doctor has seen it many times before and knows its just not that serious.

6.TOO FAT

The doctor might not want to say this even though he knows that is the probable predisposing factor to a patient presenting with such clinical conditions as hypertension, diabetes and atherosclerosis where weight loss would have prevented complications.

7.WRONG TIMING

Every doctor's nightmare is that patient with a really bad condition that comes in 5 minutes to the end of a very hectic shift who you know will keep you at work for at least an extra hour.

Thursday, January 26, 2012

10 REASONS YOUR DOCTOR MIGHT NOT TAKE YOU SERIOUSLY






Sometimes, however bad you may feel, a doctor might not take you too seriously due to the following reasons:

1. VAGUE SYMPTOMS

Classical examples include:-
'I feel like there is something walking all over my body.'
' I don't know, I am sick.'
'I can't point to the source of pain, it is everywhere.'

2. NOT TAKING DOCTORS ADVICE

Why o why are you coming back to see me when you've not taken previous medications prescribed?

3. YOU ARE TOO REGULAR

When you keep coming back with different complaints as if the hospital is your second home, the level of interest in your case begins to steadily decline.

4. ODD HOURS

Coming with minor complaints at odd hours of the night.

5. YOUR APPEARANCE

Coming to the Emergency Room impeccably dressed without a hair out of place and demanding to be seen before other patients that look critically ill.

6. MODIFYING DRUGS

When you modify dosage of drugs to suit yourself or mix the drugs with a new herbal remedy, your doctor might not be too pleased with you.

7. PROUD ABOUT EXCESSES

When you are proud about your excessive drinking or smoking habits or your fat laden diet, your doctor may not take you seriously.

8. ASK THE DOCTOR RIDICULOUS QUESTIONS

A good example I have is 'can hernia cause malaria?'

9. MAKING CALLS

You can't possibly be very sick if you make or receive business or social phone calls while the doctor is attending to you. Giggling won't make it any better.

10. LONG TERM

If you've had the problem for years and you just decide to present yourself at 2 a.m with a smile on your face, expecting the doctor to take you serious; that just won't happen.



Image Courtesy

Tuesday, January 24, 2012

BREAKING BAD NEWS


One thing we weren't taught in medical school (or maybe I was absent at that particular lecture), is how to break bad news.

When a patient who we have been managing dies, we are placed with the unsavoury responsibility of informing the relatives. This is never an easy task because you never know just how they will react.

We've been told the five stages of grief are denial, anger, bargaining, depression and acceptance. However, knowing that theory doesn't make the job any easier. Personally, I've observed the following responses over time.

1. Those that break down completely.

2. Those that ask you to still try to revive the obviously dead person.

3. The practical ones. 'So Doctor ,what do we do next?'

4. Those that are in shock and require you to repeat what you just said.

5. Those that fall to the ground.

6. Those that immediately start calling relatives on the phone.

7. The controlled emotional. It takes a while to sink in, they initially have no reaction.

8. Those that seem relieved.

9. Thankfully have never met those that accuse you of causing the death.

My personal style?

I usually select a relative I feel can best handle the news; who can help inform the other relatives in a calm manner, (and who I hope will not pick me up and throw me across the room or give me a body slam for that matter.) I then give a brief rundown of events that led to the eventual death. I also avoid using statements like ' he is dead', rather I find it more calming to say ' he has stopped breathing.'
Then I wait for the drama.


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What has been your own experience on either side?

Thursday, January 19, 2012

WHEN A DOCTOR NEEDS A DOCTOR


Yes Doctors do fall sick.

No, they are not superhuman.

The following scenarios may come into play when a doctor needs medical help:

1. THE WORST CASE SCENARIO.


like watching the sitcom 'House' where the most minor symptom is given the most terrible diagnosis - doctors, due to their exposure often make a mountain of a molehill. Thus, a sudden headache may be perceived as a brain tumor or a boil may be looked upon as the beginning of a cancerous growth.

A lot of times they are afraid to let their colleagues know of their fears (because they may confirm it) and end up suffering in silence till the symptom either gets worse or spontaneously resolves.


2. DENIAL


This is the second scenario. All the symptoms are there but the doctor chooses to ignore them ( afterall we are superhuman). Thus that headache may be attributed to stress, or the swollen feet may be attributed to wearing tight shoes or that frequent tiredness may be perceived as being due to housework.
Recently, a young doctor had a stroke whilst on a ward round and another had complications from anaemia. Both episodes were fatal.



3.
WHEN A RELATIVE IS SICK


When a doctor's relative, especially a close family member is ill, it is usually a trying time for the attending doctor who has to make sure he makes no obvious mistakes as every move or prescription will be keenly observed- This in itself can be irritating to the attending physician who will have to endure a series of endless questions and suggestions from the doctor.


4.
TAKING DRUGS.


I have not met a physician who likes to take, or is regular with medications - it is easier to admonish a patient for not taking their drugs than for a doctor to take drugs.


So the next time you hear a doctor is sick, don't blame him or act surprised - rather give him a pat on the back and say,"I understand".



image courtesy

Monday, January 16, 2012

7 WAYS TO GET MAXIMUM ATTENTION FROM YOUR DOCTOR



Indeed with thousands of patients coming in and out of hospitals these days, it is becoming increasingly hard to get maximum attention from your doctor and by extension the quality health care you rightfully deserve. But it is possible.

1. REMEMBER HIS/ HER NAME

This unconsciously makes the doctor sit up, knowing that small details are important to you, so he had better take you seriously.

2. REMEMBER TO SAY THANK YOU WHEN BETTER

This serves as a boost to the doctor's morale especially when seeing any future patients. It encourages the doctor to put in more for his patients welfare knowing that his little efforts actually yield results.

3. DON'T BE TOO SMART

Carrying pages of research you've downloaded from the internet on health care issues to impress the doctor might actually do the exact opposite. Again, coming up with a diagnosis rather than telling the doctor the symptoms you have may put him off. It does no good saying 'Doctor I think I have Malignant Mesothelioma.'

4. SMILE

Doctors dread going into a room where they know the patient doesn't have the right attitude both to his illness and to the doctor, but they do like to help and encourage a patient with a positive outlook to things.

5. HE ISN'T SUPERMAN

Of course doctors like to feel as if just a mere touch from them would heal any condition. However, it is a different case when this is actually expected of them.

6. WORDS NOT TO USE

' Doctor, as you can obviously see.'
' Doctor have you ever heard about this condition?'.
' If only my usual doctor was here.'

7. DON'T STALK

Following the doctor to his favourite coffee shop to ask your latest questions or accosting him when he is about entering his car will more than likely make him try to avoid you next time around.

Friday, January 13, 2012

THE LONELY MARRIED WOMAN - A WOMAN SCORNED.






Doctors always have that occasional patient who is deceptive.

An hilarious case retrospectively ( I didn't find it funny at the time), was the 'unconscious' young lady who was brought into the Emergency room by her husband. History and preliminary examination proved nothing significant until the husband happened to step out of the room.

That was when it happened, a 'miracle'.

She who was hitherto in a 'deep coma', opened her eyes, looked furtively around and started to talk - She hurriedly told me that this was just a set up, she was only acting. She related how uncaring and stingy her husband was and how she wanted to use this opportunity to milk him out of his money and gain his attention.

I was amazed at her skills, indeed Nollywood / Hollywood was missing a potential star here. How did she manage to keep a straight face while everyone around her was in complete chaos mode ? How did she keep from reacting when she was being moved, how could she remain so limp? Indeed, how did she remain perfectly still through all the checks on her?

I had a hard time that night, convincing her this wasn't exactly the reason the ER was set up(duh!) ,and why she had to come clean. I couldn't continue to spend anymore time 'treating' her.

It would have been interesting though, to join in her charade and watch the husband sweat out all thoughts of infidelity - but this wasn't scrubs, this was real life and I had better things to do.

I hope the husband would have eventually learnt the lesson of the wrath of a woman scorned. But again, i guess not.

Was her action forgivable?


Image Courtesy

Thursday, January 12, 2012

HEALTH: WHY HUSBANDS SHOULD LISTEN TO THEIR WIVES


In the little time I have practiced, I have come to the realisation that there will be fewer incidences of health complications in men, if they listen more to their wives.

In my day to day practice(and this is an unconfirmed statistic),it is usually the wife that accompanies the ailing or dying husband to the hospital rather than the other way round. Of course you may argue that the man is usually older and more prone to stress as the breadwinner of the family, but this is not entirely true especially in modern times.

It is often the wife that puts 2 and 2 together and then advices,'honey why don't you see a doctor about that?' She it is that notices your clothes don't quite fit anymore, or you seem to be going to the bathroom more often than usual. She notices the pillow keeps getting drenched with your sweat and your feet are looking rather funny. She also notices that rash you think is a mere scratch.

In a diabetic, it is often the wife that makes sure the husband properly follows his nutrition health advice.

A lot of times in the Emergency Room one hears the complaint 'I told him to take his drugs or to see a doctor but he refused',this is usually accompanied with sobbing especially when the case is too far gone.

Indeed,I believe if the statistics are compiled,husbands who listen to their wives as regards their health do actually live longer.
Or what do you think?

Monday, January 9, 2012

THE RISKS WE FACE



Health Risk assessment of working in the Emergency Room.

Working in the Emergency Room is like going to war, you never know what you are going to face. Like a Boyscout, the motto of an ER physician should be 'be prepared'.

One has to be prepared because the ER is a very risky place to work, it can be compared to a factory where workers have to protect themselves from getting injured.

Patients in the ER are the most unstable you can come across, so being careful goes without saying.

First of all, you have to dress appropriately and have gloves and a face mask within reach.

You have to be careful with health care equipment and needles, you wouldn't want to be pricked accidentally with a needle from a patient that has a blood borne disease like HIV.

You also have to be careful of accidental discharges by patients, an unconscious man can easily direct a fast stream of hot urine straight onto the face of the examining doctor( hopefully, the doctor's mouth would be shut).

Blood splashes are also an everyday risk: This could occur whilst trying to withdraw blood from a patient or administering some intravenous medication. Blood may be splashed onto one's clothes or get into one's eyes or mouth.


A number of times, we come across patients in need of mental health care, violent patients or violent relatives of patients, cases have been known of relatives trying to cause bodily harm to a doctor. There was a case a doctor had to escape through a window to prevent being harmed by an aggrieved relative.

Airborne exposure is another risk - a coughing tuberculosis patient may easily transfer the bacteria to an attending physician.

On a lighter note, you could also get a pass from a patient (author has had a pass from a mentally deranged patient).

Tuesday, January 3, 2012

THE WOMAN WHO BARKED


I heard her from afar - a loud, frightened and erratic babble; another psychiatric case I presumed.

I did not expect to see the timid, scared and shaking lady who finally appeared before me.

"Please turn it off, please turn it off!" She pleaded, visibly agitated and scared - the source of her fear being the airconditioning. Her fear was so palpable that I had to turn the airconditioning off.

Further history revealed she had developed episodes of "barking" like a dog. She also had a morbid fear of drinking water.

Was she mad? Definitely not. Her only offence was that she was bitten by a mad dog.

The dog died immediately  after biting her. She was not mad, she was only exhibiting the symptoms of rabies.

SYMPTOMS OF RABIES

Aerophagia

- This is the fear of air.

Hydrophobia

- fear of water due to spasms of muscles at the back of the throat.

Anxiety and depression

invariably develop.

A TOUCHING QUESTION
"Doctor am I going to die?" She asked me.

What reply could I give? Would it have benefitted her to know that once rabies is established, it is invariably fatal? or that statistics say only 2 recorded cases have ever survived?

PREVENTION OF RABIES
1. Get your dogs vaccinated.
2. When bitten by a dog, report immediately to the ER. Also, enquire if the dog was vaccinated. You may be given anti rabies.
3. If bitten, monitor the dog afterwards for unusual behaviour.