Mueni Muli

Our patient has died

I was hunched over my patient's bed, trying to get a history in the best vernacular I could master, but I was distracted. I kept glancing outside the window at a young patient sitting on the grass, busking under the morning sun, seemingly without a care in the world.

If you didn't know him, you wouldn't believe that he was holding on to life by a single thread, sitting on a fence between life and death, where the slightest breeze could topple him over. His condition was a ticking bomb, and no one knew when it would explode.

When we were dividing beds amongst ourselves, his bed number was a number too high for our numbers, and so he was no one's patient.

Yet every morning, the first thing we did after wearing our lab coats and making sure we hadn't forgotten our name tags was to check on his condition. He had become our patient.

"How is his hemoglobin today?...5!"

"Well, at least it is better than the last time."

"What about the platelet count?...6.5? "

We were baffled because we knew the normal lower limit was 150. We found it hard to believe that someone with such values could still be alive. Yet there he was, throwing stones at a mango tree, hopping that he would get something to spice up the bland hospital food that he had been taking for so long.

I suspect the same questions crossed our minds every time we walked by his bed and our eyes met.

"He is so young...he is our age...it could have been any one of us...why him?"

It wasn't long before the dam burst. We watched helplessly as our once jovial patient became bedridden and his light dwindled a little more every day. We could have taken a bone marrow sample from him so we could be sure of what he was suffering from, but who was going to stick a needle in him with those platelet counts?

We could have given him platelets but they had to come from Kenyatta National Hospital, which was near impossible. If only he could afford private hospital care, his outcome may have been different, the common tale in most public hospitals.

One morning, as we did our normal routine, lab coats and name tags in check, we noticed a patient on our patient's bed, but he was not our patient. It was futile to ask about our patient's condition, or where he had gone because we already knew. Deep down we hoped that perhaps he had been referred to another hospital or transferred to the ICU, but it was nearly without doubt. Our patient had died.

The same thoughts lingered.

He was so young... so much potential... why him... it could have been me...

We have all seen more deaths than we care to count, and yet we are still taken aback when our patient dies.

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Mueni's comment : I particularly relate with this succinct narrative, because it reminds me of a patient in the Internal Medicine wards (when I was in 3rd year) whose story went a lot like this one. We knew all his details and everyone would pass by his room every day to say hello.

Well, grace to all medics, I'm sure many relate with this. I would love to hear your views or similar stories in the comments section.

Soli deo Gloria.

by Mueni Muli

Even death cannot separate (My Patient Has Died Part 6)

I’ve wanted to write this for the longest time but it’s just been so difficult to start. Today I’ve been able to gather a few words so here we go...

Let’s call her Liz( not her real name for the purpose of confidentiality).

I met Liz during my rotation in the Newborn unit. She had just undergone an emergency Caeserian section. She looked tired. Every step she took as she walked looked painful. You could see it as she carefully lifted each leg to take a step.

Her legs were swollen following to a complicated pregnancy. She had breathing difficulties and couldn’t produce breast milk but all these didn’t prevent her from going to the nursery every 3 hours to see her new born baby.

Her baby( let’s call her baby Liz) was very sick and tiny. She had to be delivered premature (earlier than expected) . A feeding tube, oxygen mask, overhead heater, IV fluids were all in place to support baby Liz.

I decided to have a chat with Liz as she sat beside her baby. She cried as she narrated the horrible turn of events. The once uneventful pregnancy quickly became her greatest nightmare. It was her first pregnancy.

There was such rawness to her narration. The wound was open and in the midst of her sharing her painful story, I remember telling her that things would be ok though at that moment, it was almost impossible to say anything that would make the situation better.

Unfortunately, baby Liz passed on 1 day later. That was a difficult pill to swallow- I was invested in Liz’s pain. I carried her pain in my heart, thought about it and hoped for a miracle.

How does such a natural process as pregnancy end up causing harm not just to the baby but also to the mother?

The thought of the pain Liz endured to bring her baby to this world was unbearable and this weighed so heavily in my heart. It disturbed me in fact. And this was the story almost each day in the newborn unit ; where you meet a baby today and tomorrow they are gone... you interact with mothers and sometimes even give them a flicker of hope only for it to be crushed when their baby died.

My time in the Newborn Unit (NBU) and paediatrics rotation was one of the most emotionally exhausting seasons, watching countless resuscitations and most being unsuccessful. I don’t think I questioned my decision to join medical school as much as much as I did during this period.

Nobody prepared me for this.

Nobody showed me how to deal with losing patients.

No one told me that this was part of the deal- where I would watch someone die and be expected to quickly move on.

The fragility of life became so real and it was easy to be indifferent. I asked myself alot of questions-

Why do I work so hard?

What’s the point anyway when we know what the end for everyone is?

The reality is, losing a patient or just anyone you get to interact with leaves you scarred. It takes away something from you. It’s confusing and painful . I don’t even know if one can truly learn to cope because you just never get used to it. If that place exists, then I’m still learning and I’m on my way there.

However, in those moments I’ve found so much comfort in letting God in and allowing Him to take me through the pain and confusion.

I love the accuracy of this hymn- What a friend we have in Jesus

What a friend we have in Jesus
All our sins and griefs to bear
And what a privilege to carry
Everything to God in prayer
Oh, what peace we often forfeit
Oh, what needless pain we bear
All because we do not carry
Everything to God in prayer
Have we trials and temptations?
Is there trouble anywhere?
We should never be discouraged
Take it to the Lord in prayer

So I take it all to the Lord in prayer for no pain is too much for Him to handle.

I also find talking about it quite therapeutic - learning to express my emotions at that moment with no guilt. Cry if that is what it takes, journal, scream just whatever it takes to let it out.

I also have hope. Hope in eternity - that when all is said and done, we will be in a better place. This world is not our home, we are just passing by...

Every death is a reminder that I’m getting ready to go home.

“O Death, where is your sting? O Hades, where is your victory?” The sting of death is sin, and the strength of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ.”
I Corinthians‬ 15:55-57‬ NKJV‬‬‬‬‬‬

Our bodies may wear out, grow old, and die; we may be buried in the ground, but we will live on, through the power of the One who conquered death.

Where is the sting of death? For us believers it has none, for it is the beginning of a new and glorious life.

Thanks be to God, who gives us the victory through our Lord Jesus Christ.

“For I am persuaded that neither death nor life, nor angels nor principalities nor powers, nor things present nor things to come, nor height nor depth, nor any other created thing, shall be able to separate us from the love of God which is in Christ Jesus our Lord.”
Romans‬ 8:38-39‬ NKJV‬‬‬‬‬‬

Not even death can separate us from the love of God.

Be blessed.

By Winnie Abila

by Mueni Muli

Beginning of the end (My patient has died Part 5)

What would you do if you knew when you were going to die?

Would you live a more organised life? Would you make better decisions? Spend more time with the ones you love and genuinely value? Would you travel the world and explore and
discover more realms of possibilities? Would you take more risks and be
absolutely fearless? Would you write a book and journal more?

Most importantly, what would the dying moments look like?

What would it look like when it hits you that the life you have invested so heavily in, and have learnt to deeply care for, is about to be taken away from you? Would you be prepared to
it let go? Would you be content? Would you be happy?

I guess that’s all we do in life really. We pursue happiness. We want to have it. Having to lose something so precious to us definitely doesn’t make us happy.

We’d rather do all we can to fight to save and preserve it. We will live healthy. We will avoid unnecessary risks. We will pray. We will go to the hospital when tragedy strikes; or even upon the slightest suspicion of its presence.

Happiness would perhaps only come if we had the assurance of losing something so valuable to gain something even better in return.

Perhaps that’s why people
commit suicide and euthanasia. Perhaps this is an effort to get rid of emotional and/or physical suffering in the hope of something better.

Coming back to the spirit of happiness, a close friend of mine once mentioned how she thought that the hospital is such a sad and dull place. She thought it needed more colour, more spice, more life.

Well, maybe instead of hospitals we should have parties. And doctors ought to be trained in the art of disk-jockeying to allow them to give the occasional “Ikibamba sana wapi nduru!” signal to hired
professional screamers. (Translation: If you are on a high, make some noise!)
Maybe hospitals will have some colour then.

But what do doctors do in the wards in the meantime?

Well, there’s plenty of study in pursuit of the healing gem of knowledge. There’s talking to patients to try and figure out what the problem is in relation to the doctor's amount of knowledge though books and previous experiences.

There’s requesting for laboratory and radiographic tests. There’s the drafting of management plans and follow up. There’s attending ward rounds to assess progress.

However, upon progress towards healing, there is no nduru (screams of
jubilation). Doctors don’t do nduru: at least not in front of patients. They nod in agreement after hearing the words “discharge this patient” and move on to the next patient.

As a third year student in the University of Nairobi, I was excited to wear a red name tag that highlighted my usefulness in performing critical life-saving procedures like carrying patient samples to the laboratory, and fetching patient files from the nurses' station to bring to the ward round. This was supposed to be
an important step in becoming a super-doctor and I had to respect the process…Or so I thought.

All was ok until it happened. It was one of the most grotesque
encounters I’ve had to face.
An ulcer that had grown so large in diameter on a patient’s abdomen in the surgical wards that I could see his intestines popping out with pus all over. The nurses were daring enough to be covering it. The young man was emaciated and sat trembling under the cold of a chilly morning breeze on an overcast day.

The sliding windows were wide open. He was not talking but he was alive. I was torn between a mixture of compassion and helplessness. I told myself I would have a conversation with him the following morning after he had been attended to, only to find his bed empty. His breath had ceased to exist.

This was the first patient I saw die in the hospital. He had a life. He had a
livelihood. He had a family. He was no more.

Did he know he was going to die?
Did death pay him a surprise visit? What was going through his mind during his final moments on earth? Was he at peace? Was he content? Was he happy?

I keep thinking this aloud to myself as I watch people depart from this world after so much work has been put in to try and save their lives. Sometimes it’s people who are desperately needed in their communities.

They are fathers.

They are mothers.

They are leaders.

They are colleagues.

They are friends.

But we still have to watch as dependants are given room to suck it up and move on. They looked at the
daktari with hope. Now they can barely face him or her in the eye. Fundraisers to settle hospital bills are conducted and people go back to their routines, mostly still carrying the burden of absence and wondering to themselves,

“Is there a better tomorrow? Will the pain of losing such a unique individual who was part of my life go away?”

Well, doctors sometimes adapt and learn to view their profession as mere tasks that can either reap a positive fruit or fail miserably: just like any other job or business.

But others see it differently.

They grasp the opportunity to see and share in the dying moments of their patients and watch as they ponder over the quality of their relationships and review their commitment to struggle. They perhaps struggled to find meaning in life. They could have struggled for a cause they believed in.

These doctors would watch empathetically as they look into their eyes that seem to grapple with the tension that lies behind the question, “What happens next?”

By Raysam Baraka

by Mueni Muli

The Final Call: Fading Flowers (My patient has died Part 4)

A few weeks ago, my friend Joy told me that she's doing a series on death and how we, as medical students, face and handle the death of patients.

When she said so, I paused to think. Have I ever had 'my patient' die?

The answer surprisingly was no. Or so I thought. Her question made me reflect on the patients I have met in the wards and how they have impacted my life. With all the cases of death we have discussed with my colleagues, I couldn't believe none had been mine.

Needless to say, I have encountered death in the hospital. Not only its presence but its impending nature, just waiting to happen.

In my 3rd year, I rotated in the medical wards. Part of the clinical work involved taking histories and examining the patient.

On one particular evening, I casually strolled into the ward and as I usually do, scanned the room for a patient who seemed in good enough health and mood to answer a few questions and examine. I quickly spotted a middle aged man in his late 40s and approached him.

He smiled as I got closer and this caught me off guard. I had not expected to meet a 'happy person' , considering the circumstances.

At the time, I also thought that professionalism meant a straight face with an almost sombre look that matches the hospital atmosphere, but nonetheless, I smiled back.

While at his bedside, I was careful to make sure I was on his right hand side(as we are instructed to), gave a brief introduction and sought his consent to proceed.

He happily obliged and I began my clinical work. He had complaints of right sided chest pain with associated difficulty in breathing and hoarseness of voice with long history of smoking.

Before long, I was done. I thanked him and left, having a few differentials(ie possible diagnosis) in mind. Though I needed to confirm the diagnosis, so I looked at his file.

Lung cancer.

The following day, I greeted him, asking how he was faring. This time he complained of right sided chest pain, pointing to that region.

It was clear that the situation was worsening. This broke my heart knowing that this cancer was each day stealing away little of his life. A few days later, he was discharged to continue with palliative care at home.

He didn't die there at the hospital but however soon after, I know he must have.

On another occasion, I went to the A&E. I was hoping to observe an intubation(this is a whole conflict of its own). I went to Resuscitation Room 1, where people who required specialised medical treatment particularly ventilation support usually are. It's like a mini-ICU.

Shortly after I walked in, a boy of no more than 9 years was wheeled in. He appeared to be sleeping peacefully. He was not moving and was covered upto his waist with a linen.

I struck a conversation with the paramedic who brought him in. She explained that he had been referred from a hospital in Thika where he had been admitted for the last few weeks. He had not been improving hence the need for urgent referral, due to liver failure.

I asked about his current state and she whispered that he had passed on the ambulance ride. His parents who were anxiously standing outside the room were not aware of the situation. They kept popping into and out of the room to check on him as if they knew but didn't want to believe it.

Nothing could be done at the time until the doctor confirmed that he was dead. It was an awful situation to be in. Each time his parents walked in to ask what was happening all we could say was we were waiting for the doctor to arrive. I can't begin to imagine what was going through his parents minds at the time.

After about 10 minutes of waiting I decided to leave. It was too much to take and I didn't want to be there when the news was broken to his parents.

Death has such finality. Despite the fact that it is certain, the uncertainty of how and when can be really crippling. My conclusion from my experiences is therefore, to make every moment count. To live as one aware of the fleeting nature of life.

As for man, his days are as grass: as a flower of the field, so he flourisheth.
Psalms 103:15 KJV

By Kathleen Kabeu.

by Mueni Muli