A memorable patient

My title is taken from the British medical Journals BMJ where physicians can send in a write up on a patient they have managed whose personality, condition,peculiar characteristic still lingers even when they are no longer managing such persons.

This is my own version of the BMJS own series.

She came in when i happened to be on the emergency room call about two years ago, she had been knocked down by a vehicle while walking along the road in her hometown in Iseyin. She was brought all the way to Ogbomoso by relatives who felt she would receive better care at our facility but the journey had taken its toll, she had sustained an open right distal tibiofibular fracture and had bled considerably.

I don't know how far apart Iseyin and Ogbomoso are but the poor lady had suffered untold stress and had lost a lot of blood.By the time she arrived she needed to be resuscitated with lots of intravenous fluids but the main thing she needed was blood. Unlike in developed countries where blood is available for the asking from the blood bank personnel, blood in my country remains a very touchy issue especially when it comes to getting donors.

The concerned relatives who had thus far suceeded in bringing 'mama iseyin' all the way from Iseyin practically melted away when the issue of blood came up. The question 'ta lo ma feje le fun eniti e gbe wa' (who will donate blood for this patient) always has a magical way of causing a dissappearing act amongst the relations, friends and wellwishers who somehow seem to descend in droves whilst accompanying the patient to the hospital.

From the moment we mentioned blood it seemed that no one wanted to be held responsible as the primary health giver. As this was the case sorely needed funds needed to procure drugs, pay an admission deposit and pay the fees to have her wound flushed in the operating theatre dissappeared with the so called relatives. They virtually dumped her in the ER and left.

That was the beginning of mama iseyin's travails. She was taken to the theatre to have her wound debrided and then transferred to the ward despite the relations reluctance to be involved in her care, of course her leg suffered tremendously as a result of this lack of care. Intravenous antibiotics needed were bought in spurts and bursts. Of course the relations did not donate blood and a little begging got us a pint of blood which hardly made a difference in her overall condition.

Why was 'mama Iseyin unique, through all this she never voiced out any complaints and she was full of thanks for the attending medical personnel. As i was the house officer in charge of the female medical ward, i was always inundated with her statements expressing her gratitude. Before you got to her bedside she would greet you with such a charming smile that your initial annoyance at finding out once again that she had no drugs was quicly dampened.

She would then proceed to thank you for looking after her and of course as is the usual practice with women her age in this environment she would start to bless you, your family and generations yet unborn, even when her daily dressings were done in the theatre and you would inevitably cause her some pain she would continue thanking you with such good grace.

I can still hear her lilting voice saying 'thank you my child, thank you fo taking care of me, thank you i am very grateful and on and on she would go' almost wearing you out with her grateful song.

The turning point for her came when we realised that the limb was too badly infected and had to be taken off, all of a sudden all her relations reappeared as magically as they had gone away, one of them in particular was her husband, i had seen him from a distance several times and each time we had asked for him he was always never around. This time without our asking for him he showed up and was the most vocal. He demanded her immediate discharge against medical advice. Our inital shock at learning that she actually had so many relations wore off quickly as our anger at their callous behaviour increased.

We eventually had to accede to their request but there was still one more thing left to be done. Since her limb was splinted in our metal backslap her relations had to make one from wood so she would not leave the hospital with our splint. It took them several hours to do this and as i was the HO in charge of her i was finally called to make the transfer of her limb. I decided to do this not alone but in the presence of her relations who had never seen her limb without it being covered by a dressing.
I asked their assistance and proceeded to undress the limb, what they saw caused them to avert their eyes and begin to gag, i refused to allow them such a luxury and i demanded that they look at it. That was just the trick that was needed. The relations helping me where her children and they quickly rushed to their father to describe the horrid scene including the fat maggots feasting on their mothers rotten flesh.

They very quickly consented to the surgery and mama iseyins foot came off. You can bet she was still full of thanks, i guess she was happier living without the horrid stench that had previously emanated from a part of her body.

A few months later when i was walking along the hospital corridors i heard someone hailing me i turned back and saw a young woman and another young woman just behind me, the only difference was that one of the young women had no right leg and she was using crutches. I tried very hard to remember where i had seen that face but i did not need to guess too long, for she spoke just then and as you have guessed she said,'dokita e seun mi ijosi, e seun gan modupe' (doctor thank you very much for the other time i am very grateful.

It was 'Mama Iseyin" looking more like a sweet sixteen with her head tie jauntily placed on her head than a mother of grown up children!