theDoctor
ONE ON ONE WITH DR. WAFULA NALWA, THE CARDIOLOGIST

Too posh to push

too posh to push

Too posh to push

Bringing forth new life is meant to be one of the happiest experiences a mother can ever have, but labor ward is, for lack of a better word, agonizing. Images of women screaming and writhing in pain are difficult to clear from one’s memory let alone picture oneself on the delivery table. I have heard stories of medics who walked into maternity once and simply never went back. Now picture one of these well bred, sophisticated long nail, expensive weave, high heel wearing, harrier driving middle aged career ladies who are simply too posh to push. Picture them being harassed by a nurse to push harder, to lift their buttocks and to pass stool right there, not withstanding, other people are watching.

simply too posh to push

Now picture the above lady as a doctor. Say a young resident in radiology , newly married and only learning how to balance her busy school work with family, and now about to bring forth the life that is her precious 1st born after the long wait that is the journey of becoming a doctor. She is simply too posh to push, isn’t she?

the push

This is a story of one such doctor; who’s cultured sophistication and a desire for privacy saw her lose her life and with it, a surgeon’s entire career.

Call her Dr. Emy, was the typical woman I have just described. (… although being a doctor, the nails might not be too long or the heels too high, but you get the picture). Luckily, for such women, an ancient practice that has now been perfected into one of the simplest and most commonly practiced surgical procedures is in place and they do not have to push. Caesarian section on client’s demand is on the rise as more and more women and couples are made aware of the benefits it carries. Ladies who are simply too fancy to have a 3Kg newborn with a circumference of 30+ cm through their jealously protected lady parts alongside agonizing pain is not a conceivable thought. A few minutes of anesthesia and a small cut on the abdomen that might be too subtle to notice within a few months of discharge seems like a better bargain. And if you ask me, it is.

as old as it gets

But surgery is surgery, and every surgery has a risk. Dr. Emy was a resident radiologist from UoN and had been posted to kilifi county hospital for electives when her pregnancy was due. She was not ready to push. But thanks to the advances made in the medical field, she didn’t have to… They say as a doctor, it is always better to be attended to by your colleagues, because it is hypothesized that they will take care of you with love and care and give you the best outcome. But when you think through all that which your body would be subjected to, in the process of any medical intervention you might, for a moment, consider being treated by an equally qualified total stranger. The thought of such vulnerability before the glaring eyes of your colleagues, ah ah!. Dr. Emy, now one of the lead radiologists at Kilifi county hospital did not want her colleagues to see her in that situation. She did not want her workmates, with whom she interacted on daily basis, and was only beginning to built a respectful working relationship, to be the ones seeing her at her most helpless. She sought for strangers.

She got in touch with one of the private practice gynecologists in kilifi town who agreed to perform the CS on her at a private facility in the outskirts of the hot weather coastal town. “All we need is an operating room, right!”. An elective procedure on an otherwise healthy, normal pregnant woman (ASA 1 as they would put it) in the presence of an experienced gynecologist; what could go wrong?

Her surgery was scheduled on a Saturday, the doctor did everything right. And on that beautiful Sunny Saturday morning in May of 2019, they were ready to bring Dr. Emy’s bundle of joy to life without any pain, without unnecessary struggling, pushing and screaming.

In theatre, however, being a Saturday, there were very few anesthetists. But God works in mysterious ways, doesn’t He! One of the surgeons at that theatre, known to not only be good at his surgeries, but who also had a unique reputation of having the ability of occasionally doubling up as an anesthesiologist, had conveniently cleared his list for the day and was more than willing to lend a helping hand. Well, its shocking, but not surprising; as medical students, doctors go through an anesthesia rotation and as surgeons, doctors are almost always around anesthetists and anesthesiologists and the delicate machines. So, it wouldn’t come as a surprise that in our human resource poor country, a surgeon who is confident enough to double up as an anesthesiologist would grab the opportunity, to not only help out but also make a shilling in this dwindling economy.

Plus, doctors are busy, the gynecologist scheduled the surgery for this particular time because he has other places to be, and postponing when there is no obvious hindrance would be a waste of time, and as they say, time is money.

So, as fate would have it, the surgeon offered to help. He had done this several times before, it was nothing new. In fact, at times, he has been both the anesthetist and the operating surgeon, putting the patient to sleep then rushing to scrub and perform his surgery (legendary), all you need is someone to alert you if the vitals are not as expected, plus with all this technology, the machine will beep in protest in case anything is a miss.

Dr. Emy, is carefully put under spinal anesthesia and within no time the surgery is underway. Our surgeon anesthetist has, just like that, made a penny while helping out a colleague. He is on his phone, in and out of the operating room, waiting for the surgeon to be done and he be on his way to the next patient, the next hustle. Actually, when you come to think about it, anesthetists have the easiest time in theatre. Once you put your patient to sleep you can hum along to your favorite music as the surgeon struggles. Well, think again! Anesthesia is the most delicate of all medical practice. It is a tight rope to walk, a balance between life and death. It might seem easy when everything is going smooth, but the minute it takes a nose dive, you have a very narrow window to save your patient. And that is why they take 3 to 4 years to train; it’s not just about fixing lines and tubes. For Dr. Emy’s case, the spinal anesthesia did take a nosedive and the mood quickly shifted from simple elective to DEADLY EMERGENCY.

under spinal anesthesia

As an effect of spinal anesthesia, patients can, though very rarely, develop high spinal. Which within such a short time will result in severe hypotension, poor organ perfusion and before you know it organ damage. As sad as it sounds, that is what befell our innocent, young, full of life Dr. Emy. What was supposed to be a simple procedure had now got doctors in panic mode trying to pump her with fluids to try and raise her blood pressure. Her baby had already been delivered and was receiving care next to her in the operating room. Dr. Emy on the other hand was fighting for dear life.

With neither of the two specialists being a specialist in anesthesia, Dr. Emy was fighting a loosing battle. Their efforts to either save her or call for help were too little too late. Dr. Emy found herself in ICU. Severe Brain damage. She was moved from hospital to hospital doctor after doctor, specialist after specialist across the entire Coastal region. But the damage had already been done. Dr. Emy, after months of hanging on to dear life, finally passed away while being nursed at an ICU in Mombasa. She was laid to rest at her, barely enjoyed, marital home in Malindi town. She never got to hold her bundle of joy, she never got to nurse and raise her long-awaited baby. She will never get to see her make her first steps or hear her say mama for the first time. May she rest in peace!

 Her baby will have to grow up without her mother. She will never know a mother’s love. Stories of how her mother passed away while giving her life will give her sleepless nights, but she will be okay.

to push or not to push

I wouldn’t know much about Dr. Emy’s family. I can’t tell whether she was an only child or one of many, whether her family was rich or they were looking upto her to finally give them financial footing, either way it is inexplicably painful to lose one of your own. Her parents must be grief stricken, they say time is a healer, I don’t know how much time it will take them for their hearts to heal and for them to forgive or even forget. Maybe never. Her husband must have been infuriated. Maybe the law would provide some solace.

The gynecologist should have taken better care of his patient. He should have waited for the necessary qualified personnel. But let’s cut him some slack, this could never have been anticipated. For the Surgeon anesthetist, the least said about him the better. He should have known and kept to his lane. You can’t always be lucky. Licensed or not, he was operating as a quack, in a field he had not trained. He had no chance before the medical board. He was deregistered! And now, his practice has ended!

by Nyadimu

Disclaimer: the above story is fictitious and not about any particular individual.

Nyadimu Festo MD

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

1 comment

theDoctor

Find the latest News on matters of Health in Kenya

ads