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ONE ON ONE WITH DR. WAFULA NALWA, THE CARDIOLOGIST

It’s not your call

Do not be quick to to write anyone off. A lesson I learnt from an experience with a patient. An experience that I have hardly forgotten. While at ward 7 at JOOTRH ( ward 7 is a male medical ward), a male patient, in his mid thirties, was referred from Kisii Hospital for ICU care. The man had had an argument with his wife and consequently, maybe out of frustration, he took uncountable glassfulls of changaa and an unknown poison. He was unconscious, and that was the reason for his referral to JOOTRH.

On arrival, I took the patient’s history from the forlon wife and the shocked brothers. I examined the patient: In summary, there were barely any sign of life. The GCS was 3! The patient only had a faint heartbeat. Nothing else. No pulse, nothing. Unfortunately, to make matters worse, the ICU was full (talk about limited resources).We had to monitor the patient in the acute room in the general wards! He was on high flow oxygen and the nurses were close by incase things went from bad to worse. My patients chances of survival if any were slim to none. Usually, such a patient required an ICU care as a bare minimum to at least have a fighting chance; or so I thought. The family couldn’t afford to be admitted at the nearby private hospitals; Avenue or Aga Khan Hospital.
I, therefore, in no uncertain terms, explained to them the prognosis, bearing in mind the patient’s dire condition and unavailability of an ICU bed. I told them that the patient was going to die!! And that they should be prepared for that. The wife cried. She was dejected and in distressed. Probably because she felt guilty or would be acused of killing her husband. His brothers looked withdrawn as if looking into a bleak future, a future without their beloved brother. The fear of never being able to be with your loved ones is anguishing. My shift ended and I went back to my house.

The following morning, when I came to prepare for a major ward round, I got the shock of my life. Initially, it looked like a weird dream. But it was not. I thought saw the patient’s ghost. Well, it was no ghost, and it was no dream. It was my patient! The one I was sure would not see the next day.He was sitting up on the edge of his bed eating and talking to his wife and the brothers. I have never been more ashamed. Looking at them, the wife gave me glance- a glance that said a thousand words. Words that could not and would not be be spoken. The brothers looked at me as if I was a villain who had wanted their brother dead. I avoided eye contact with shame written all over my face. I was embarrassed! But I had learnt my lesson. A timeless lesson.

As human beings, and as doctors, however educated, however powerful our knowledge and power is still limited. Our understanding of God’s works is still just a drop in the ocean of what God can do. However much we may think we know, still, we learn that it’s only much.

Doctors often write off patients, sometime with strong evidence and statistics to back it up, only to be humbled when the patients they wrote off pulls through. Only to see such patients walk out of unimaginable pits of conditions. Only to be embarrassed when patients walk out of ICUs and comma. One thing I learned from that experience is that as long as one is still alive, there is hope. They can not be written off. Not by the best doctors in the world, not by anybody.Probably, that’s why, during rescuscitation, we continue with bagging as long as the heart beat is still audible.

Never rule out anyone today because of their current condition, however bleak. Even as the young doctor I still am, I have seen people that I thought wouldn’t amount to anything become great people. People I look up to. I have interacted with people doing amazing things despite being despised before. I have seen homes that were written off become places that people admire. And almost everyone knows a story of someone that amounted to something despite being ruled out as a nobody before. Even the moral cop, Ezekiel Mutual, while eulogizing the late president Mkapa admitted previously, he wouldn’t have been allowed to even eulogize a village headman! But here he is today, eulogizing a former president of a country.

When everything is going on well for you, do not look down on anyone struggling today. No one knows what tomorrow holds. No one can see the future. And none can predict it. If you’re strong, don’t look down on people who are weak today. If Goliath was alive, he would know this better. If you are healthy, don’t look down on anyone who’s sick. When on a higher ground, don’t look down on anyone in a pit. For who knows tomorrow? Who can say with certainty how tomorrow will be? No one.

By Dr. Victor Oduor

Nyadimu Festo MD

Medical Doctor. MBChB with IT (Maseno university). Passionate about medicine, writing and leadership. Voice of the Kenyan doctor.

1 comment

  • I think this was a case of acute alcohol intoxication. I have had to deal with such cases and the presentation is typical with decreasing GCS .Once the alcohol is cleared from the body the patient wakes up like a miracle but in really sense no miracle happened.
    Supportive care to avoid aspiration pneumonia.

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