DIARY OF AN AFRICAN MEDICAL DOCTOR

Day 63 to 67: Well, this is a price for selling our best player

2010-01-04T07:18:00.000-08:00

The last 5 days were very hectic for me. I was moving from town to town with my cousin who is a big politician in my state. to make matter worse there was no internet service.

I am starting my annual leave tomorrow and during this period, I will devote most of my time to studying for my forth-coming primary examination.

My season came crashing today when we lost against Leeds. This performance is unacceptable, how could this happen?

Well, this is a price for selling our best player.

Diary I am hibernating for a while and I might resurface to write once in a week until I finish my leave.

Day 61 and 62: How i did my first amputation

2009-12-30T09:02:00.000-08:00

We cancelled our cases today because our house refused to submit operation list to peri-operative nurse, orthopaedic ward and anaesthesia department.

My boss gave me query and gave the house officer a week extension in orthopaedics.

It is not easy to be a leader.

We reschedule the surgery to the following day.

This morning I did a quick revision of amputation, hoping my consultant will allow me to do the surgery.

Thank God, after some begging and proof of my capability to handle the case he oblige me.

Well it went well and I am very happy I was able to do the amputation successfully.

I made two equal anterior and posterior skin flaps at about 12cm proximal to the knee joint. I expected the skin to retract proximally and so it did. I cut the fascia just at edge of the retracted skin to expose the thigh muscles. I then raise my muscle flap at the cut edge of the fascia. However, on the medial side I have to dissect the muscles layer by layer to avoid cutting the big vessels. I identified the sciatic nerve, retract it upward and cut. I separated the femoral artery from vein clamped, tied and cut.

I exposed the femoral bone by pushing the soft tissues upward and then saw off the bone. I chiselled off the edge and then closed each flap layer by layer.

I hope I have a wonderful postoperative period.

Day 60: Pleomorphic sarcoma of right leg soft tissue with tibia invasion

2009-12-28T07:47:00.001-08:00

After Sunday service today, I went to Bucky’s (my paranoid friend) house to return her iron bowl with which she prepared my chicken the other day. She called me twice to request for the bowl but what I could deduce was that she was more interested in seeing me.

Arsenal seems to be flying now and we once again struggle to win our match. As I said the season is beyond us and if we win, it will be because of other clubs undoing.

I called my house officer to ensure the preparation of the two cases we intend to operate on tomorrow. First case is pleomorphic sarcoma of right leg soft tissue with tibia invasion; we plan to do above knee amputation. The second is a case of multiply injured patient who sustained fracture of femoral shaft, neck and tibia plateaus; our plan is to do open reduction and internal fixation.

I received another two visitors from home today. We are now four in my house.

Day 59: I really which club like villa and spurs can take the initiative

2009-12-27T05:44:00.000-08:00

I am happy Chelsea draw today but I would have been happier if they lost that match because they did not deserve to draw.

This season is somehow, it is as if all the big four are passing through poor spell period. I really which club like villa and spurs can take the initiative. Well, I have a feeling Manchester united will win the league though the league is for Chelsea to lose. I pray we win our match tomorrow because nowadays you cannot really be too sure.

I could not wait to finish watching Liverpool match, I later learnt they won by two goals margin.

One of my cousins left today.

I got home around 8pm and unfortunately, there was nothing at home for me to eat. I have to drink garri with chicken (garri is a form of cassava flour but not refine).

I watched surrogates today before I went to bed.

Day 57 and 58: Merry christmas and happy new year in advance

2009-12-26T09:13:00.000-08:00

Thursday

I woke up so late this money. Thank God today is public holiday because I would have not been able to bring my self up if it had been normal working day.

I went to see my paranoid friend today. She is on duty; she works at our computer department.
I told her she has multiple personality disorder stimulated by ex boyfriend who broke her heart.
I asked her if she might want to come to my place today but she told me she would be going out with one her neighbors.

One of my cousins came to visit me today from Akure. He just finished his degree program at federal university of technology Akure.

Sekemi came to help me cook stew and vegetable soup to entertain my visitors against tomorrow.

Friday

Today is Christmas and I have made up my mind not to travel. I believe I am old enough to receive and entertain visit on Christmas day.

Many people came to house today and after an elaborate meal and we discussed about football, national and hospital politics.

My paranoid friend showed up with another friend of mine who she claimed to be her cousin. For the first time I did not step of my house today.
Sekemi accused me of dating a nurse who helped me bought fowl from hospital cooperative market.

The girl is highly obsessive and I do not even know if it is an advantage to our relationship or not, but sometime, I felt she was taken it too far.

Day 56: She is so paranoid about having an affair with a medical doctor

2009-12-24T09:24:00.000-08:00

As the Christmas and New Year approach, many of our patients refused to come to clinic.

We only saw about 10 to 15 old cases, 2 new cases and 4 emergency cases this morning.

Tomorrow and Friday have been declared public holiday by federal government. As a result, we did a quick ward round after our clinic.

I asked someone to help me get a fowl in my hospital cooperative market but before I could get home, I noticed it has stopped breathing.

I went to a woman’s house today; she is so paranoid about having an affair with a medical doctor. She said doctors are liars andwomanizer. Is there any man who does not like beautiful woman?

I do not even know what to do about her, she is an extra ordinary woman and I, with all my experience with women, felt some thing different about this one.

She refused to come my place this evening and I begged her to help me with dead fowl. She told me she could not visit a guy who came to her house for the first time. She told me to drop the fowl and she would help to tidy it up at her place but she would not come to my house.

Well, I eventually left for my house around 8:30pm after enough persuasion.

Day 55: His Pack Cell Volume came out to be 20%

2009-12-23T07:37:00.000-08:00

Today is my round and association of resident doctors are having their election.

The skin grafting I did last week failed to take and the patient refused repeat skin grafting.

We had four patients over the weekend with one of in bad shape. His Pack Cell Volume came out to be around 20% and needed to be transfused with two unit of fresh whole blood.

He was multiply injured patient who has fracture of right radius and ulna, communnated mid shaft fracture of the left femur, displaced fractured neck of head of femur and fracture of left tibia plateau.

We planned to take him to theatre for open reduction and internal fixation as soon as he stable for surgery.

All the candidates I voted for lost in today’s election. I left for my house in a sober mood.

Day 50 to Day 54

2009-12-22T08:42:00.000-08:00

Usually my diary is the last thing I do for the day, but because of lack of internet service where I stay, so I blog it the following day. That was why it appeared late most of the time except when I am on call.

As I said about five days ago, I was not in town in the last few days because I went to a friend wedding ceremony.

I travelled a long a distant across another geopolitical zone to attend the ceremony. In Nigeria, we have six geopolitical zones. I reside in southwest zone and I travelled to north central zone.

By the time, I came back on Monday I could not even take my bath let alone write my diary.
The ceremony was very eventful though I could not get any new female friend number. I think I am becoming more satisfied with Sekemi.

Last weekend was bad for my club and I cannot remember the last time we lost with that kind of margin without scoring a goal, probably against Milan in champion league semi 2007 at San siro. I learnt we are meeting them again next year; God help us. Well, Chelsea and Liverpool having bad results too limited the damage.

The end of the year is fast approaching and I cannot see one significant thing I have done. I hope and pray next year is different.

Day 49: I am reading anatomy first

2009-12-17T07:37:00.001-08:00

Christmas is fast approaching and usually most patient in this part of the world prefers not to have their surgery during this period. In fact, nobody wants to be admitted for now. Because of this, our clinic was very light today. By 1pm, we were through with our clinic.

I have started reading for my primary examination in surgery. I am reading anatomy first. I spent most of my remaining time today at library. I went home around 7pm.

I am happy Chelsea faltered this evening though they were able to win via a controversial penalty. Arsenal surprisingly drew their match and Liverpool undeservedly won today.

Diary, this is going to be my last daily write up for the week. I am going to a doctor’s friend wedding ceremony. The place is very far, about 6 to 7 hours drive. The event will take at least 3 days from me and there is no internet facility where we are going. I will see you on Sunday.

Day 48: Nurses here in Nigeria are more interested in fighting doctors than helping them.

2009-12-16T08:57:00.000-08:00

Today is my ward round but before we could start the round, the Chief Nursing Officer of male orthopaedic ward called to inform me of one of our patients that was gasping for breath. I reviewed and immediately commence on intranasal oxygen, Intravenous Fluid and I have to pass NG tube for feeding.

Our ICU no longer functions and in this hospital, you have to solve most problems yourself or your patient will die before the unit you call comes to review the patient.
In addition, to make matter worst most of our nurses are incompetent and are more interested in fighting doctors than helping them.

I make up mind today to do my residency in surgery (orthopaedics) rather than Obstetric and gynaecology. I am falling in love with orthopaedic surgery.

My cooking gas got finished yesterday, I send a doctor friend to help refill my cylinder against tomorrow at Akure. There is no gas station in Owo. I have to eat out tonight.

I got home around after 7pm and settle down to enjoy our match. I will have to say the match was boring though I was able to stay glue until the final whistle was blown before I went bed.

Day 47: I am on call

2009-12-15T07:22:00.000-08:00

My consultant asked me to do the skin grafting while he would take the amputation.
Of course, I have not done it before but fortunately, for me the plastic team were around in the theatre. I have to beg the plastic surgeon to release one of their registrars to assist me.

After the surgery, I went to doctors’ common room to write financial report of our health week programme last week.

My house officer called to inform me of the demise of the post-amputated patient following pulmonary embolism. She died some hours after the repeat amputation.

I am on call today, so I have to stay over the night. I asked Sekemi to call DSTV man to help solve the problem with my HiTv and DSTV. She later told me the problem have been rectified.

My call has been peaceful so far.

Day 46: First patient is a case of peripheral vascular disease

2009-12-14T10:51:00.001-08:00

I came to hospital this morning to prepare three of my patients for surgery against tomorrow.

First patient is a case of peripheral vascular disease following diabetic foot. While the second case is an old wound, which has refused to heal after an amputation in a 70-year-old woman who was involved in a road traffic accident.

We planned to do above knee amputation and skin graft respectively.

I was however informed that the anaesthetist cancelled the third case because he was not fit surgery.

Though I prayed for draw in today’s match between Liverpool vs. Arsenal, I am happy Arsenal won the match.

My satellite TV refused to work again after the match. I really wish this is not a serious problem. I will have to see the DSTV man tomorrow.

Day 39 to 45: Health week and Humanitarian Service

2009-12-13T03:32:00.000-08:00

Diary I am sorry I have little or no time to write my daily activities. It was a hectic week for me and I could not just do any other thing. Thank God, I am back and health week programme is now behind me.

Last seven days were days I was truly proud to be a doctor in Africa. I was able to give back to the communities that have spent so much to train me. We were able to cover six communities where free drugs, health education and free consultation were provided.

We were unlucky; we should have gotten at least a point today. Well, the good news is that Chelsea drew their match against Everton.

I hope for draw tomorrow between Liverpool and Arsenal.

Day 37 and 38

2009-12-06T03:18:00.000-08:00

Friday is always my favourite day. We were able to arrange 11 doctors to each centre with one of them acting as a team leader. I know most of our volunteer doctor can still change their mind, so we ask each team leader to walk on their member and make sure they show up on Tuesday for the outreach.

The chairperson of the committee travelled to Lagos today to buy glucometer and strips, which we will use to do random blood sugar during the programme.

Sekemi came to my house later in the day but she refused to help me cook anything. She told me I am having an affair with another woman and that I should let her go her own way. Woman can lie; she talked as if she really wants to leave me. She was only interested in blackmailing me to abandon all other women in my life.

I eventually cooked indomie nodules for dinner when I could not convince her to help me with something.

Today (Saturday) was a great day and it was marvellous in Manchester united fans.
I started today by acquiring a viewing centre where you can watch premiership and other league matches. I really hope I can make some extra money from this.

We won our match today with a big margin and tantalisingly Chelsea and Liverpool lost and drew respectively. What a wonderful day. We are now 2 point behind the league leader despite our long injury list.

After the match, I went to see Sekemi who no more think ill of me.

Day 36: Preparation

2009-12-04T05:44:00.000-08:00

I am officially not working for now because of our health week preparation.
I met with Obas and chiefs to finalise how the programme will be held in their various communities.

I learnt that our president in this country is ill and he had to be flown to Saudi Arabia for proper medical management. Sometime I feel very low as a Nigerian and obviously, this is one of those periods. Our hospitals here are glorious health centre with little or no facility and with little take home pay for doctors. We cannot even boast of one world standard hospital.

I am having malaria symptoms; I went home early after my journey to treat myself.

Day 34 and 35

2009-12-03T07:42:00.001-08:00

Preparation for the humanitarian programme taken place next week had consumed most of my time yesterday and today.

I thank God my consultant is not around or else i would have not been able cope with work load.

I travelled to Akure to buy drugs and materials to be used for our free health programme.

Today we went to the six communities that will benefit from our free health programme.

I am so tired and I need to go and sleep.

Day 33: Our health week is starting next week

2009-12-01T09:30:00.001-08:00

My consultant is not in town. Therefore, we did not prepare any patient for surgery.

We did a general ward round and we agree that the diabetic foot patient will benefit from above knee amputation. We will have to inform Dr. Adeitan, the surgeon deputising for my boss to assist us.

I have been able to convince my cousin friend to sponsor our community outreach programme. He gave us eight hundred thousand naira (around $5000). I am going to be very busy this week. Our health week is starting next Monday.

I had an emergency meeting with executives of Association of Residency Doctors. I told them about the money I was given and we discussed how it should be spent.

We later had general meeting of the association where we finalised most of the plans for the programme.

I watched prestige before I slept.

Day 30, 31 and 32

2009-11-29T15:49:00.000-08:00

I was in the hospital early on Friday morning to see the patient I did wound debridement for his legs. The smelling had significantly reduced and he is improving though the medical team are still battling to control his blood sugar.

I spent the rest of day watching movies in my house.

I decided to stay in door throughout Saturday but after spending some hours sleeping and reading, I went to Akure to visit madam speaker.

I am happy we won today’s match after initial scare by Pompey. The penalty given to Pompey was the worst I have seen in a long time. Is as if the referees are out to punish us. Of course, I know Chelsea will win tomorrow.

I came back from Akure today. I got home around 3pm.

I have two important matches to watch today. One is el-classico between Real Madrid and Barcelona and the other is a derby between Arsenal and Chelsea.

Chelsea was too strong for Arsenal to handle and Pellegrini made a tactical error by substituting Ronaldo. I would have loved arsenal and real Madrid to win.

Tomorrow is another Monday and work surely will start tomorrow after four-day holidays.

Day 29: She asked me in a derogatory way

2009-11-27T07:47:00.000-08:00

I got to theatre around 10am and I was immediately confronted by the most senior peri-operative nurse; she wanted to know if could handle the case. She asked me in a derogatory way. I of course did not answer her but referred her to the registrar in my unit.

We started the case around 12 noon and by this time, the whole theatre smelt of gangrenous tissue. More than 70% of the right foot is gone while the whole of little toe of left foot was already auto amputated. After removing as much as possible dead tissues, I tried linking all the sinuses together then wash with hydrogen peroxide and copiously irrigate with normal saline. Surprisingly there were bleeders on the exposed deeper tissues. I dressed with gauze and crepe bandage then informed the nurses to commence on daily wound dressing with honey and continue present antibiotics. We also asked the medical team to ensure well control blood sugar.

I spent the remaining part of today working on the net and reading. Sekemi called to apologise and my patient girlfriend, Toyosi called me today to know when she should come to visit me.

I got home around 7pm and I watched star trek, Madagascar, and terminator salvation before I slept. Remember I have an off day tomorrow.

Day 28: I told him the man would need amputation

2009-11-26T09:04:00.000-08:00

Sometime I wonder why Alex Ferguson refuses to retired as coach of Manchester united. To me, the man is now more of problem than solution. He could decide to lose a match by choosing to field a weakened team without considering the fans. What I know is you field your strongest team, and then when you are comfortably ahead you can bring in your young and inexperience players.

Federal government declared Thursday and Friday as public holidays for Muslim festive period. Today is our last working day of the week. My unit is on call so I cannot travel, though I am not on call but my consultant asked me to stick around being the most experienced in the unit.

My boss called me around 4pm after the clinic to meet him in his office. He told me to go to the theatre to do the extensive wound debridement of the diabetic foot we admitted on Tuesday. Of course, I told him the man would need amputation. I eventually cancelled the case and reschedule it until tomorrow morning because of lack ambulance to carry the patient from the ward to theatre.

Sekemi and I had a fight today because of her perennial excuse that her mother would not allow her to stay with me. I went to sleep thinking about the procedure I am to do tomorrow morning.

Day 27: Twelve passengers died and were taken to the morgue

2009-11-25T04:59:00.001-08:00

We now have eighteen new cases; all of them having multiple fractures of the limbs. There was a head on collision between 18 sitter bus and luxurious bus along Owo and Akure road. Twelve passengers died and were taken to the morgue. Most of these people are yet to contact their relatives.

My consultant asked me to contact social welfare services on their behalf and see if we could help anyone before their relatives come.

My boss joined me in my ward round today because of these new patients we admitted. Most of these patients require urgent surgery but because of financial constraint, we could not take them to the theatre. My consultant did everything possible to assist them but there just too many.

I have not slept in the last 24 hours and I had reached a point where I might break down. Thank God, I am not on call today.

After it was certain that none of the patients would be ready for surgery today, I left for my house around 7pm to have a cold bath and good night rest.

Day 26: He threatened to issue them query

2009-11-24T07:28:00.001-08:00

I got to theatre early today and surprisingly my consultant came to the theatre around 8am. I was the only doctor in the unit that was there. My boss was so annoyed that he told other doctors in the unit to go back home. He threatened to issue them query.
I personally do not want them to go home because I cannot do the work alone. They were later allowed to report back after someone begged on their behalf.

We had three cases today. First patient is a day case who came for removal of inter-medullary nail of the right femur. Our second case is that of 37-year-old male who had segmental fracture of left tibia with malunited lower fracture line and non-united upper fracture. We initially wanted to insert interlocking nail but we have to abandon procedure and instead reduced with plate and screw.

The last patient is that of chronic osteomyelitis that we did seqestrectomy on left femur. We left theatre around 3pm. I am on call, so I could not going home.

I was invited to review a case of septic arthritis in a 2-year boy. I placed him on intravenous antibiotic after arthracentensis.

I also saw a case of diabetic foot today. The patient leg has to be amputated and unfortunate for him both leg are affected. My consultant is thinking of saving both legs. However, as for me I think the earlier the better.

Day 25: How could Wigan allow this to happen?

2009-11-23T13:55:00.000-08:00

I learnt this morning that Tottenham defeated Wigan 9 goals to one. This is the heaviest I have seen in a long time in any competition. How could Wigan allow this to happen?

I got to know that most goals scored in a single premiership game was between Portsmouth and reading during 2007/2008 season, Pompey defeated reading 7 goals to 4. While the highest goal margin was between Manchester united and Ipswich in 1995 when the score was nine goals to nothing.

I could not go anywhere this morning because of the lady friend of my friend in my house. I had to wait for my friend to come before I could go out around 4pm.

I came to hospital to update my diary and see my patients who we are preparing for surgery tomorrow. I had to make sure all the necessary materials like orthopaedic packs and blood are ready for each patient or else we will not take their case tomorrow.

Sekemi later called me and told me she was waiting for me at home. By the time I got home, she had prepared fried yam with egg for me.

I was able to finish watching “public enemy” and “state of play” before I went to bed.

Day 24: Some time I think we men take it too far

2009-11-22T07:50:00.003-08:00

I went to the hospital this morning to update my diary and did some other work on the internet. I can only access internet in the hospital. Today was full for me but not that eventful.

I have three football matches to watch one after the other and I must say I am very happy with the results of all the matches except that of Chelsea. Well I did not expect wolves to defeat Chelsea anyway. I am beginning to have confidence in our team and I am more than happy with our display today against Everton.

Aside football I would say today did not go the way I expected it to be. Sekemi was supposed come today after her lecture but she was no were to be found. She called me later to give me one stupid and lame excuse on the reason why she could not make it. I would say I have never seen myself got that angry on the phone. Probably women think that we men are idiot.

A friend of mine was in trouble today and had to call me to rescue him. His fiancée called to inform him she would be spending the night with him when he was in fact with another girl of his. Therefore, the girl had to come and sleep in my place. Some time I think we men take it too far.

I finished the remaining part of '' Harry Porter'' and I even watched about an hour of ''public enemy'' before I slept.

Day 23: What A Country

2009-11-21T02:08:00.000-08:00

I went this morning to surgery weekly presentation about HIV/ AIDS in Surgery. Around 16 minute past 10am, my consultant gave me a signal for us to go and start our round.

Our round was business like today. No question was asked, probably my boss want to get out of town fast. We were through with the ward round around noon despite the fact that we saw all patients in the department. We are to prepare three patients for surgery on Monday.

Diary, I told you yesterday how much tired I am of this country. This morning I was going through some dailies and what I saw made me to be ashamed of my country.

"The budget presentation is one of the most important, if not the most important event in the life of any government and any nation. Apart from being a national event, which gives all Nigerians indication of how their welfare will be taken care of by the government, it is also of international significance since it is a major gauge by which trading partners and investors will determine their attitudes and relationships with Nigeria in the coming year."

However, to my surprise the senators and House of Representatives are fighting about whose chambers should host the joint presentation.

"Nigerian federal lawmakers are perhaps the best paid in the world, yet they are turning out to be the least productive. The only time people hear their voices are when they are involved in one scandal or another or when they are haggling over their disproportionate perks."

We all know what happened about three days ago when the Queen presented her annual address; the House of Lords is a much smaller chamber but everybody, including the much larger House of Commons had to come to the House of Lords and everybody stood up until the presentation was made.

I really hope they come to their senses and allow this presentation before the end of this year.

My patient girlfriend finally left today.

I got home around 7pm. I cooked nodules and had cold shower. I watched about thirty minutes of harry potter and the half blood prince before sleep kicked in .

My quotes are from Nigeria guardian daily newspaper.