The Ritual (My patient has died Part 10)
As a cherry 💠on top, we finish this series with a gripping spoken word by Eugene Muthumbi, my classmate.
The ritual he speaks of is one I vividly remember. In fact, this never ending ritual is what inspired this entire "My Patient has died" series. Paediatric deaths do something to you. 😠Enjoy the video and share widely!
(Ps-if you're using your phone, it's best to play the video in full screen)
The Ritual
Spoken Word by Eugene Muthumbi
Breathe in. Breathe out.
Breathe in. Breathe out.
White coats scurry around the room.
Illegible notes are scribbled into big blue cards.
"Sister, do you think we should up the phenobarb for this one?"
The nurse just shrugs.
The 6 year old's intractable seizures
Are not enough to shake her.
Meanwhile,
Across the room,
A little girl tries to drink in the air
Being fed to her through a mask.
Breathe in. Breath out.
Breathe in. Breathe out.
White coats scurry around the room.
Illegible notes are scribbled into big blue cards.
Doctor is now debating between phenobarb and midazolam,
But the nurse tunes out his droning.
Instead she wonders if her husband will come home today;
Maybe the bottle will be what he holds when he sleeps tonight.
So she instead chooses to toy
With the mental image
Of a certain Dr M:
Tall, bearded, well built, intelligent.
She feels a familiar heat down under;
Australia and her, same wozzap.
Meanwhile,
Across the room,
A little girl tries to drink in the air
Being fed to her through a mask.
Breathe in. Breathe out.
Breathe in. Breathe out.
White coats scurry around the room.
Illegible notes are scribbled into big blue cards.
Student wants to ask the doctor
Why that patient is still on ceftriaxone
Despite a clear CSF screen.
But Doctor is on phone.
So the student sighs heavily;
Lets his mind wander,
Wondering what mom will make for dinner today.
Meanwhile across the room,
A little girl tries to drink in the air
Being fed to her through a mask.
But this time?
This time she fails.
She tries again.
She fails again.
Her mother chains her own breath to her lungs
In solidarity with her daughter's apnea.
Waiting.
Waiting.
Twenty seconds pass
And Mother can no longer hold vigil.
She gasps for the air
That her daughter's lungs have lost taste for.
Her gutteral wail moves them all into action.
The nurse carries the girl across the room
Swaddled in KNH branded sheets.
The curtains are drawn.
Mother is still wailing.
Resuscitation start time: 4:19pm.
The ritual begins…
Airway… Clear.
Breathing… No chest movement.
Student gives 5 rescue breaths.
Pulse… Radial pulse not palpable.
Doctor gives 15 chest compressions.
Then 2 breaths.
Then 15 chest compressions,
Then 2,
Then 15,
2..
The nurse comes back with a syringe;
Pumps the girl's veins with adrenaline.
The ritual continues.
15, 2, 15.
Mother wails.
15, 2, 15.
Sweat drips.
15, 2.
Wailing
15, 2.
Clock ticks,
15.
Wailing,
15 -
Stop!
There is no benefit in resuscitating after the 10 minute mark.
At least that's what the nurse says.
The little girl lay there,
Her lungs now a haunted house,
Filled only with ghost stories.
Time of death: 4:31pm
…
Student goes home.
He tries to write.
But there is no poetry in death.
There is no poetry when you know
You will reconvene in a few hours
To repeat the ritual.
There is no poetry when you know
You will repeat the ritual
Until you become the ritual.
And in the end,
We all become the ritual.
But until then…
Breathe in. Breathe out.
My patient has died. The end.
A 10 part series! Who'd have known we had all these stories to share? Thank you so much to the guest writers who made this possible.
Thank you dear reader, for your continued support. Make sure you subscribe via email to the blog (scroll to the bottom of this page and you'll find the subscription box).
Also, what suggestions do you have on future issues/topics I should write on? Share them in the comments.
Soli deo Gloria.
A counselling psychologist's experience(My patient has died Part 9)
I had just begun my attachment at the hospital and super eager to do a good job.
"Work hard so they take notice of you and hire you" said ALL my relatives.
I was one of the not so lucky ones that got thrown into the deep end, the critical care unit. There didn't seem to be anyone to counsel or offer the kind of services I was trained to provide. Just loud machines I did not understand how to read. (No, all the medical series didn't help. At all)
It wasn't long before we were hurdled into a room for what we thought would be orientation. Three strange men followed, the last one was broken, bereaved. I could tell because death gives everyone the same sombre look.
Our supervisor informed them that their brother has died, she answered all their questions, and made them feel that even though it wasn't going to be easy, we did, really, do our best.
With time I'd learned the ropes. In a couple of weeks, I was doing the same, explaining the prognosis and breaking news. It was never easy.
I'd always pass by bed 21 afterwards; the patient who almost died but didn't. He was the only conscious patient I had at that unit. He was said to be depressed and stubborn. Though at some point, we were more of friends than patient and therapist. He knew how to live, laugh and love even when surrounded by death. He knew how the bodies were wrapped;
he'd lost count of the new neighbours he'd seen being wheeled to the mortuary over the years.
Even so, 21 was hopeful. He was going to recover and be home in time to watch the world cup.
Being around for so long afforded me the opportunity to meet his family, sadly, his kid brother was never allowed to visit (hospital rules). But they'd made plans to make up for the
birthdays he had missed.
21 would suggest series for me to watch and ask for strange sandwiches, or just the eclair he'd occasionally crave. I couldn't bring him any (again, hospital rules), but the series were good.
One day when my colleagues and I were making our rounds we met his grandmother in the
corridors and she was excited!
"My grandson's birthday is on Saturday, we'd love for you to come and celebrate with us! "
I didn't go, I hear it was amazing. The cake was large! ( I made a
point to bring him his sandwich to make it up to him though.) 21 was happy as he'd been informed that he'd be going home in a couple of weeks!!
They assigned me to a new unit. I had new patients, many critical... but I knew I needed to make time to visit 21. I didn't. He was to go home soon anyway so my job was done. He was no longer depressed. Heck, he was excited and always laughing. My colleagues said he was doing great!
He had a minor surgery scheduled for that night to have his bed sore patched. Simplest of surgeries! He'd had such invasive ones before, this was nothing.
Days passed and I forgot. We forgot. We had new patients, and news to break to families. Some of us had new ropes to learn. (New departments and what not.) Occasionally we'd talk about 21 and how we'd forgotten him. But he would understand, he
always did when we disappeared.
It was the Monday after what felt like a long weekend when we bumped into our supervisor from 21's unit. She didn't say hi, she waved though...Which I thought was fine.
"She's busy, we're busy. Let's visit 21 today" we decided.
21 wasn't there.
"Oh, he was supposed to go home! We'll just call him. "
21 didn't pick up.
Then our supervisor called and had us meet her.
"21 died in surgery."
Why do I call him 21? Because that was his bed number. Also, I unlearned his name. I'm sure I could find his name in my phone book if I looked hard enough, but I don't want to.
My work was not done. When 21 died we had to break the news. We had to explain to his younger brother why they couldn't have the birthday parties they had planned. We had to explain to his family what happened, to debrief them and have them receive the news in the best way
possible. I'm not sure that is possible any more, but that's what they teach you to do.
21 taught me, my patients are not my friends. I viewed his body. I hoped he'd wake up. I did not want to answer his grandmother's questions. I wasn't his doctor. I don't know his doctor. I did my part. I helped him cope, adapt, conquer. All of that still meant nothing once they'd put
him under. Sheer willpower, high levels of self-awareness and self-worth are useless when
you're not conscious.
Do I regret having had 21 as my patient? No.
Would I take up another critical patient? Yes, I just won't take their phone number.
There are other 21s now. Some die, some go home.
I went home that evening and when asked how my day was, all I said was, "my patient has died."
Mueni's comments: Our second last post in this series and what a story! Thank you Maria for sharing this with us.
What are your thoughts on befriending patients? Is it a slippery slope for medics or does it strengthen the doctor - patient relationship ? (whether you're a medic or not, I think we can pick your brain on this. )
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.
Subscribe to the blog for more updates and share widely. 2 more in this series to go!
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.
My brushes with death (My patient has died Part 7)
It's said that after birth, the only guarantee is death.
I think that's why, when asking me to throw in my two cents, Joy didn't start with 'have you ever lost a patient?'. Instead it was, 'would you want to write about it?', with the assumption that, especially as a medic, I have had my brushes with death.
I don't have a specific story though. When this first came up, I didn't immediately think of one particular patient - rather, my first thoughts were the products of a number of experiences - so instead I'm going to expand on the common elements of what I'll call, for lack of a better term, 'the motions'.
It's almost like a set script. As a medical student, you meet a random patient. Maybe you find them on the bed assigned to you. Maybe they're the only one who was awake when you went to 'clerk' (a term for talking to patients and getting their histories and examining them)…or maybe you just happened to be in the vicinity when they wanted something and you ended up talking. It doesn't really matter. The outcome is the same: contact is established.
This is a different type of acquaintance that you make though. You start off as complete strangers, and within an hour's time, you're…not friends, exactly, but a semi-intimate bond does form. By the end of the hour, you know all about this major turning point in their life - the thing that's brought them to hospital (which to us isn't a big deal, but for any 'civilian', I can appreciate how significant it is) - as well as a lot of other details that you don't share on the first meeting with others, such as their family trees, other illnesses they've battled…and sometimes even how many windows their homes have. In and of themselves, most of these random facts have no bearing, but they do serve to make you feel a stronger connection to the stranger before you
That's step one.
Things can progress in a number of ways then, depending on the specific condition, but often there is a phase of 'strengthening' that connection. It's small, daily advances you make as you check in on them to see how they're doing, ask about complaints, answer their questions…the interactions don't last too long, but they do serve to build up enough of a 'base' such that when you step into the room, your eyes first seek their bed, their eyes. You feel that rush of warmth that accompanies familiarity, and you see it reflected in their expression too, and those mini-check ins become a cozy little daily ritual that you don't think of too much.
Then one day you find the bed empty, because they're dead.
Was that jarring?
I'm sorry.
That was kind of the point though - that's sort of what it feels like.
I wasn't entirely accurate, because sometimes you find a new stranger in that bed, but in terms of 'shock impact', it's actually been comparable for me whether or not I knew it was coming.
Understandably, it's the unexpected ones that shock you a little bit more, where you're left stunned and wondering as to why things took that turn, but even when your patient was extremely sick and you knew their time had come, it still jolts you. What's different, I guess, is that the initial 'OMG' is soon followed by a kind of gratitude that their suffering has ended, at least.
If this isn't bittersweet, I don't know what is. There's relief for them, on their behalf, as well as sorrow, and it's then that you realize that, despite your knowledge and accurate assessment of the probable outcome, you had been hoping that this would be the case that would beat the odds.
At that point - the point of revelation, you're a little dumbfounded and you don't quite know what to say, so you 'okay' it and just get on with what you're doing…and once again, each situation is different, so I can't really even make broad strokes, but eventually you get to this point of having taken it in stride and having moved on.
It sounds extremely callous, I know…but life really is like that. The whole experience is comparable to being hit with a strong puff of perfume - initially, it's intense and heavy around you, but as time passes, it dissipates away and you're left with just a memory.
The world carries on. The file gets wrapped up with a brief summary, and the 'deceased' label appears next to your patient's name in the admissions register…and that's it.
For you, anyway.
I imagine this is a new, terrible sort of beginning for the patient's family and friends, but that's not what this is about. This was meant to be about the medical students' perspective, and for me, after having run a number of these circuits, I've gotten to this a new understanding of 'the big picture' that I didn't have before.
Life is short, and in the grand scheme of things, we are so insignificant I won't get to see what happens following my own death, but I have seen enough to make a fair approximation of how it'll go - and the bottom line is, the world is going to carry on just fine.
It sounds depressing and defeatist, but please don't get me wrong: this is just a stepping stone in the stairwell that leads to my ultimate, not-so-original conclusion: our lives are but flickers of a candle against a backdrop of the Sun, so we might as well make the most of it.
It sounds dehumanizing and insensitive to say 'everyone will die, death is no big deal', but I say it with all the appreciation and reverence for life itself. Death is a given. Once you come to fully embrace that, you're able to free up any mental energy that was spent being apprehensive about that outcome, and appreciate even more greatly the life part of the journey.
Not that death is an absolute necessity to be able to appreciate life, of course…but again, that's besides the point.
The appreciation for the here and now has simply been one of my biggest takeaways.
Another one relates to how inspiring and brave people can be. I can think of a couple of patients with poor prognoses, who knew what was coming, and were still unfazed. They weren't stoic, really…rather, I think the word is 'graceful', and it's truly so inspiring! If they can do that with the ultimate endpoint, I feel there's no reason I can't apply it to everything else that happens in life, you know?
The other strong emotion I've felt in this situation is…well, heartbreak. It's so heart-wrenching sometimes to see someone's fears, or the impacts on those dependent on them, or - and this one hits you hard an entirely different way - a parent's pain and despair when the patient is but a child. At these points, that it happens to everyone isn't of much comfort. It doesn’t even change anything for that family, anyhow - the wounds remain just as raw.
I realize this sounds like an incomplete thought, but that's really all there is to it. You see that pain, and you feel it too…and that's it. There's nothing else to be said or done about it.
I guess, that's just life.
And from my end, that's death, too.
Thanking my lovely friend, fellow poet and writer, Aditi for this deep sharing, quite timely in this season of the pandemic.
Do share this article with someone you think it'll encourage. 😊 Plus, stick around for 3 more articles in this series coming by this week. Follow and subscribe to the blog so that you get them straight to your inbox!
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.â€
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.â€
Romans‬ 8:38-39‬ NKJV‬‬‬‬‬‬
Not even death can separate us from the love of God.
Be blessed.
By Winnie Abila
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?â€
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?â€
By Raysam Baraka
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.
Death (My patient has died Part 3)
Before the last decade, I had probably gone for one funeral, known only one person who was family who’d passed on...
Death was a very foreign concept to me (but somehow, greenhouses gave me the creeps when I was 7 because I somehow associated them with death).
I had never for one time had to sit down and go through the motions of sickness, death and grief. Maybe it was the naivety of being a child. Naïve is too strong a word. It was the innocence that came with being a child.
Fast forward to October 2016, I was staring at an empty bed, a bed which for a couple of weeks had been occupied by a sweet lady who happened to be the first patient that I ever clerked.
I didn’t want to ask the question of which I knew the answer to. I was simply a third year medical student, fresh from her pre-clinical years, what did I know of death, especially death in the workplace?
This woman had become part of my routine. Get on the lift by 8:45am, reach the ward, go greet her and find out how she slept then go join my colleagues waiting for the ward-round or teaching to begin.
She had a terminal illness and all she needed was a couple of Kenya shillings to get a procedure done that would increase her quality of life and the time that she had left on this earth. (A side note, get insurance. We can wait all we want for Universal Health Care all we like but for as long as politics is involved in issues dealing with the health of a people, you’re practically on your own).
Every day she seemed to get worse and worse and looked more cachectic than ever. She also saw where she was headed towards, so on that morning when I came and didn’t find her and found that empty bed, I knew what had happened.
I didn’t want to go and look at her file or ask the nurse. I kept it inside, pushed it, shoved it at the back of my mind, learning how to compartmentalise.
Isn’t that what we needed to learn to do?
How else would I learn to separate my emotions from school or work?
As the days went by, you could hear a family crying, screaming, wailing after being broken to the news. This was a daily occurrence, every day, we’d see death.
Once it was in casualty when a child who was simply eating porridge was being resuscitated for 20 minutes without any success. It started to get to me, slowly but surely.
Back home, we’d just buried a relative and other family members were getting sick. I eventually reached my breaking point. I questioned everything I knew.
Did I want to be in this? Be a part of this? I don’t think so.
I hit a slump but thankfully, the months that followed, our university went on strike and it afforded me a chance to take a break from all of it. I took a step back and I started dissecting my emotions, the ones I’d decided to shut off.
I needed to do that, I realized. It helped me unpack a lot of what I’d decided not to deal with. It helped me move on. It made me look at things maybe a bit differently.
On some days, I’d sit with my grandmother and she’d help me see past the sickness and death. She’d give me a different perspective that was filled with less science and with more realism.
It’s roughly 3 years later and I’ve seen more deaths than I imagined I would have and I am still ambivalent about it.
On one hand, I keep telling my friends that death is a surety for as long as you’re breathing. It's something that each and every one of us will have to deal with, either professionally or personally. Such are the complexities of this life.
On the other hand, it isn’t normal the sheer amount of deaths we see as health professionals and there’s learning and relearning that needs to be done concerning how we’d need to not only deal with it but also help loved ones of patients deal with it.
I read an article the other day written by an emergency medicine physician from the States who begged the question of how as a doctor, as the one who’ll be the bearer of bad news, how you’d want a family to remember you besides you having to deal with it.
My only hope is that I will not lose my humanity through it all.
Peace! Rachel Ngonyoku.
(Thanking Rachel deeply for honestly expressing a silent fear among medics. "My only hope is that I will not lose my humanity through it all.")
Do comment, share and follow the blog for more on this series. Thank you for all the feedback and support so far.😊
Lessons about life, from death
5 things I learnt about life from a morgue: Chronicles of a medical student
As I have done before, here's an audio narration of the blog, for those who like to literally 'hear it from the horses mouth'!
https://soundcloud.com/joy-mueni-muli/lessons-about-life-from-death
(I personally recorded it so, do tell me in the comments if I should keep on doing it.😉)
For the readers, do proceed...
Quite the ironical statement huh? Learning about life from a morgue.
Being around dead bodies isn't the best experience I must say. It, however, is something medics go through quite frequently. Not only in the wards, but in emergency casualty settings and for students in particular, while in the Anatomy and Pathology units.
Pathology happened to be among my last rotations in my 4th year of medical school and boy wasn't I glad! I needed time to build morale for going to the morgue.
Yes, I had been around cadavers in first year, but this time, things felt different. There's something about a morgue where different bodies come in each day versus an anatomy lab, where every group is assigned one body for the entire year.
Also, back then we were green, learning about muscles and all...so I don't think it hit me then as much as now. Another irony.
Oh well, some of my friends who had started with the Pathology rotation came back with gory stories. Stories told over and over again, I wondered whether it was cathartic or whether they retold them for the mere reason of seeing me squirm in my seat each time. The grimace on my face was a grim visual of how I really felt.
"They remove the inner organs ruthlessly;they grab the trachea and pull out all the insides."
"The sound they make when they crack open the skull, kkk! If that doesn't scare you!"
The worst one, in my opinion, was..
"You know they usually stuff back the organs in no particular order."
"Wait, you mean they don't arrange them back into the body ?
" Nope. The brain is shoved back in the abdomen with everything else."
"Gosh! Must we really go to the morgue?" I asked.
I'd never postponed something like I did entering the morgue. This time, I wasn't trying to be the ambitious student who went and studied ahead. Nope. This time I waited until it was inevitable.
My day did come, of course. And I tried to be as brave as possible. I, for one, knew that I had to be with someone while entering the morgue. Thankfully, we got in as an entire class, so I wasn't alone. Praise God!
Besides the fact that I wasn't doing this alone, I was comforted that I wasn't the only one who had these feelings. The gentle reassurance I received from the classmates in my rotation was heart-warming.
We found more than 5 bodies awaiting autopsies. I had been in a room full of dead bodies in anatomy, as I said, but this time it was different. These people had just recently died. Their blood was still fresh. Some having died in accidents and had their skulls crushed...hmmm...
Amidst all this, my mind was a storm. A flood of many puzzling questions:
"How is it that one minute you could be walking, breathing, talking and the next, your heart stops beating, your brain stops thinking and you're gone?"
"Does life really amount to this? "
"Why such painful death? "
"Are they really dead? That guy looks like he's just sleeping."
These and many more questions rung in my mind for the entire 2 weeks while at the morgue. I then purposed to share a few things I learnt about life, while there so here it goes.
1.Our bodies are vessels.
Looking at the bodies lying there, I knew that these muscles, bones, hair, faces..these bodies we have are just a container for our souls and spirits. I finally understood the analogy of the body being a vessel.
Because, as the postmortems went on, it boiled down to so and so's liver, heart& brain weigh this, this & that... Just organs. And everyone had those. Some bigger/smaller than others depending on the body size, but eventually, those people were more than just their organs.
I can't look at those organs and say 'these organs put together' is person X. Nope. Person X's spirit is no longer there. Their body was just a vessel for them while they were here on earth.
2. Life begins at conception.
Seeing a foetus in the womb of their mother was one of the most heartbreaking moments.
Seeing the forming limbs, face and body after cutting open the womb, checking for the placenta attachment and measuring the foetus' weight...
That, guys, was evidence to me that life begins at conception. The life lost wasn't only the mother's. There were two lives lost.
3. There are many questions we may never receive an answer to, and that's fine.
The cause of death in a postmortem isn't really 'this patient was stabbed by her boyfriend' or ' he was hit while crossing the road'. Pathologists search for the real reason they died. For example, they had an MI( heart attack), broken ribs following trauma, brain herniation after bleeding etc. And the answers may not always be found.
Now, when the postgraduate was doing a postmortem on the pregnant lady , we searched and searched for what could have caused the death since her history was so sudden.
She'd gone to the hospital complaining of abdominal pains and died while at casualty. We didn't find anything grossly wrong and so we had to take tissue for histology to observe further.
I bet the relatives must have wondered;
"Huh? What do you mean no answer yet?"
Well, I guess the same thing could be said about so many life situations. No answers to what seems like never ending questions.
I'll never forget this verse my high school Chemistry teacher gave us when we had many questions concerning the death of a classmate.
"There are some things that the LORD our God has kept secret; but he has revealed his Law, and we and our descendants are to obey it forever." Deuteronomy 29:29 (NIV)
4. Human life is like a vapour in the wind.
A child playing with friends is run over by a car. Dies immediately .
A pregnant lady complains of abdominal pains. Dies while at casualty.
On and on the stories go...
I wonder how pathologists do it. Being around death all day isn't funny. One day, I got home, opened Ecclesiastes on audio Bible and listened to it. This is the book in the Bible that I'd thought was a bit 'too morbid', but trust me, it seemed like the only appropriate thing then.
Ecclesiastes 1:2 The Voice (VOICE)
Teacher: Life is fleeting, like a passing mist.
It is like trying to catch hold of a breath;
All vanishes like a vapor; everything is a great vanity.Ecclesiastes 12:8 The Voice (VOICE)
Life is fleeting; it just slips through your fingers. All vanishes like mist.
One minute here. The next minute gone. It all made sense now.
That leads me to my last lesson/reminder...
5. Appreciate life.
Your own, and that of those around you, while they're still around. Having lost a close friend last year, I know this all too well. Treasured moments with her, I hold so dear.
I examined my life and wondered why I would spend precious moments in bitterness, anger, fear, vanity...(You know those things yeah? Enhe.. Add to the list...)
That's precious life time spent on what is absolutely unnecessary! I'd rather love, laugh and live! (hmmm.. if only I knew what this really meant when I put it as my Instagram Bio @muenimuli)
But guys, isn't this always our resolve when we go to funerals?
When faced with death, I think the true human response to life is seen. Where we prioritize the basics.But when busyness takes over, we go back into the same cycle of, in a friend's words "majoring on the minors and minoring on the majors."
That's basically what Ecclesiastes is all about btw (so I figured). Solomon had it all (I mean, let's not even discuss this😂) , and had tried everything, but when he left God out of the equation, nothing satisfied him.
There is purpose in life, and it is found in knowing God and keeping His commands. That’s why he ended his book in this way:
“Now all has been heard;
here is the conclusion of the matter:
Fear God and keep his commandments,
for this is the duty of all mankind†Ecclesiastes 12:13 (NIV)
A human life lived to the exclusion of any consideration of God is meaningless.
What lessons have you learnt about life, through death? Either of a loved one, family member, friend or witnessing one happening... Do share it in the comments. I'll be waiting to hear from you, my dear reader.😊
Also, feel free to share this blogpost. I'm sure there are people in your life whom you have had this conversation about death with(as morbid as it is).
Ps- Do check out this video by the Bible project! They did a great job at explaining our fleeting life, according to Ecclesiastes.
https://youtu.be/lrsQ1tc-2wk
Grace and peace!
On Matters Premarital Sex
Medicine is all about facts and what better proves our days at the hospital than photos! Haha…so here are a few more pictures of us at the hospital.
While at the hospital, we were alarmed at the large number of cases of teen pregnancies. It was heart breaking to sit in and listen to a father filled with grief, as he explained what led him to bring his teenage daughter to the hospital. He had just come from reporting the case at the police station and needed us to fill in the P3 forms and carry out a pregnancy test. Somehow, along the way I figured that although the father had reported the case to the police as rape, it was actually a consentual act between her and her schoolmate at their boarding school. But to protect his daughter, he reported it as so. The doctor roped me into the conversation to give my advice, seeing as the young girl would have to drop out of school, following regulations that the Tanzanian government had just instated concerning pregnant girls in schools. We gave both the parents and the young girl counselling but it sure did leave me thinking about matters abstinence and sexual purity, even in the presence of pressures of peers and raging hormones.
This led us to then carry out a training at a local high school concerning SDG 3: Good Health& well-being(with a focus on Reproductive health), SDG 13: Climate action and SDG 15: Life on land. It was in partnership with the Environmental club at SUA University, Morogoro. Language barrier was quite interesting as Kiswahili is the national language. Our Taiwanese friends are the ones who had a hard time, though we translated a lot for them. Though I too was nervous at first because it has been a while since I translated some words, especially medical ones, to Kiswahili.
I’d like your input on something though. After the talk, a young man walked up to Chacha and I and shared his heartfelt desire to abstain despite pressures from his peers. In particular, he asked: "Sometimes I get the urge to engage in sex. What should I do at such moments?"
For the first few moments there was silence. I knew at his age, adolescence had just kicked in and hence, his vulnerability to open up was very admirable. We thought for a short while and gave him a few solutions on what he could do. Considering he knew the dangers of pre-marital sex (Tony and I had just done a skit about that, where I'd pretended to be pregnant etc), he needed action points.
Hence why I ask, do you think that the society has made it hard for young people to ask such vulnerable questions? What influence do our beliefs and culture have on the methods used to address this issue? What should we do to reach out to young people, especially concerning sexual purity? What’s the best approach? I have my two-cents but I definitely would love to hear your opinions in the comments.
There are so many more stories concerning medicine, but I’ll share just one more. This one touched me because the mother was a lady my age. It even led me to share on my Insta-stories later that day, especially because it taught me a thing or two about grace. #WhileIwasAway #42daysinTanzania
(Most photos were taken by our lovely photographers: Maggie, Tony and Makini)
PS- I'll be sharing more about my trip tomorrow, not necessarily about hospital/medical related things. So stay tuned. :)