Tell them to be compassionate...

"Doc, you don't want to go into that room" The nurse was giving me heads up. I was about to do my rounds, and although the comment was welcomed I still had to see my patient. As we walked towards the room I tried putting away any prejudice.
So I put on my mask then walked into the room; after all, this was the isolation ward with numerous TB patients. Soon after my entry, I realized that no amount of cover-up could mask the stench that filled my nostrils. I walked to the patient's bed. Her very massive left leg, oozing foul-smelling pus, immediately caught my attention. She was there, seemingly clueless as to what was happening to her body so for her to keep whatever was left of her dignity I had to act normal (even though my nose was having a heart attack). I inquired about her life and the course of her illness. I turned to her husband who'd been standing there the whole time. I had a mask and was complaining about the smell yet this man hadn't left his wife's bedside.

Characteristic KS lesions: violaceous plaques 

This wasn't TB; it was Kaposi Sarcoma, a common condition in AIDS patients. She was 23-years-old and had four children at home. Uneducated, she could barely keep her story straight. Her husband, a farmer twice her age, filled in the blanks often. I was touched by their humility but saddened by reality. So much that I asked Mr Sam, her husband, to test for HIV. When he declined I realized he too must have been dreading the same thing. After addressing his concerns, he finally took the test and..........was HIV positive as well. Giving him post-test counseling was difficult and emotionally draining, but his wife was very sick and needed our complete focus.
Kaposi Sarcoma is a cancer caused by the human herpes virus 8 (HHV8). There are four different forms of KS, but the AIDS-related variant is most likely what my patient had. KS is an AIDS-defining illness meaning that its diagnosis along with a documented HIV infection is conclusive for AIDS. KS can also affect HIV-negative people (as is the case for other forms of KS), but it tends to be more aggressive lethal even in HIV-positive people especially if their immune system is very compromised (CD4 count below 200).
AIDS-related KS isn't curable but the lesions will regress if the immune system is reconstituted with Anti-retroviral therapy (ART). Chemotherapy could be of additional benefit if the disease is widespread as was the case with my patient.

So the cancer team came in and wrote my patient up for chemotherapy. Mr Sam, with a lot of difficulty, managed to pay the 1st of four rounds of chemo needed for his wife's regimen. Unfortunately, she died before we could even administer it. I felt a deep compassion for Mr Sam and his bereaved children.



References:
1) Image1:"<a href="http://commons.wikimedia.org/wiki/File:Kaposis_Sarcoma_Lesions.jpg#/media/File:Kaposis_Sarcoma_Lesions.jpg">Kaposis Sarcoma Lesions</a>" by OpenStax College - Anatomy &amp; Physiology, Connexions Web site. <a rel="nofollow" class="external free" href="http://cnx.org/content/col11496/1.6/">http://cnx.org/content/col11496/1.6/</a>, Jun 19, 2013.. 
2) Image2:"<a href="http://commons.wikimedia.org/wiki/File:Kaposis_sarcoma_01.jpg#/media/File:Kaposis_sarcoma_01.jpg">Kaposis sarcoma 01</a>" by M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara - M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara: Cutaneous lesions of the nose. 

Cleaning out the attic...

This man I know gave a testimony in my church. He'd been in a motorbike accident the previous day and had his pinkie finger cut off. Yet he stood there with a huge smile on his face, thanking God. I felt like asking him to shut up. Was it irony or just plain insanity? Well, it turns out after examining his injury, the doctor had told him that the whole hand would be amputated. And since he was a carpenter, that would have been a major disaster. So I can totally understand that he was grateful to keep his hand, but I wasn't over the fact that he'd lost a finger. I realized that this man was in a place, emotionally, that I couldn't access. That he had something that I wanted but wasn't sure how to get it.
So there I was walking through Central Park, New York. Four years ago, in this same city, I had a serious falling out with close friends, which led to a cascade of other events that unmasked personal issues that I've been struggling with. That's when it dawned on me that perhaps all this time, I was the problem. And that I was holding on to things such as unforgiveness and selfishness that had become a hindrance to me.

Then I thought about God. A verse in Psalms says that as high as the sky is above the earth so great is his love for those who seek him. He loves me more than my mind could ever fathom, and this fact challenged me to be better. It challenged me to let go of whatever was holding me back. Maybe this trip to New York wasn't random after all. It was time to clean out the attic. And maybe after doing that, I could finally behold the full measure of joy that the man had experienced. The kind of joy that makes you praise God even when circumstances dictate otherwise. I thank God for opening my eyes to see my faults; I thank God for new beginnings and I definitely thank God for New York City (ah-may-zing)!!!

Who are M E N???

Now with a busy job, I can’t blog as often for the hours are always gone! I can’t even find time to shop (window shopping of course). I’m hardly Carrie from Sex & the city, but lately, there’s been something on my mind: MEN Men Men!!! Perhaps because the year is quickly wrapping up and a look back isn’t inappropriate. I remember my New Year resolution and a bold request for “emotional rollercoaster’s”. Someone said: mind what you ask for you just might get it. Well, I got what I asked for but don’t regret it because what doesn’t kill you makes you stronger. 

So men have been on my mind. Dudes. Guys. Males. Why are men the way they are? I studied the science of human beings. You know, what they’re made of, how they break and how to fix them. Some psychologists think they have them figured out but that’s BS. I wasn’t taught how human beings think, but since I spend so much time talking with them it can only come to me naturally. Yet there’s something about men! These people are bizarre. Have you ever seen a group of people walking around like everything is under control? Even if inside they're a mess? And women have learnt to go along with the charade (the smart ones anyway). I consulted a lady who had a sexually transmitted infection and when I explained to her that her partner had to be treated as well, I was surprised when she stepped out of the room and returned with a bunch of questions. Her partner was waiting in the lobby because he felt that confiding in me would make him look vulnerable (and real men are never vulnerable). That I found fascinating!

Having been involved at a personal level a few times, I realize that men are all different from one another, but just like any other human being made by God, are love creatures too. They will care despite carefully built-in appearances and will expect those feelings to be reciprocated.  They will feel bad after treating you poorly (even if an apology may never surface). And they will fight for the ones they love…because it’s inborn and they simply can’t help it.

I always take my dad as an example. The man hardly shows any sign of life (phone call, email, whatsapp, viber) unless it’s an emergency. He finds no interest in attending life-changing events such as birthdays, graduations and weddings. And talking to him sometimes is like talking to a wall; he’s not listening. 

Yet I don’t need proof of his love; it’s everywhere: he took care of me like a princess; he named me after his mother, the most important person in his life and when we’re in the same room the world stops. Literally and figuratively. I know the man loves me.

Finally, I turned to God; as the Divine Maker I figured He would have answers. But I never gathered enough courage to ask him why. I realized that women aren’t so simple either, and on that note, I chose to proceed with caution. I also realized that men will always be men, and that’s why we love them. Why bother then?

Jean Paul Tedga himself !!!

The Big deal about Tb

Tb (Tuberculosis) was just another disease that I'd learnt about in med school in the US. It was a very bad disease with a very long treatment. And if you had it you were probably an immigrant from India or some African country.
I was surprised back in Cameroon when my first HIV/AIDS patient who presented with a lung infection became a topic for discussion amongst my young colleagues and myself. While it was clear to them that Tb was high on the list, I was thinking of PCP, which is also a bad disease but as I came to realize, is less common than Tb. So we never really found out which one of the two my patient was suffering from, which is often the case so we treated for both. 
Several months later, in a teaching hospital, I was exposed to a wider array and diversity of medical conditions. But I still kept bumping into Tb...in its multiple forms: patient has a  chronic cough-Tb; patient has a big belly-Tb, weight loss-Tb, patient has a big heart-Tb too. Tb was everywhere!!! So I learnt that it could be pulmonary ie in the lung (and which everyone knew of) or it could be extra-pulmonary ie outside the lungs. 

A normal chest Xray. Courtesy of WedMD

Chest Xray of pulmonary Tb (look at right upper lung)

And outside the lungs, Tb could affect any organ ranging anywhere from spacing outside the lung (the pleura) right down to even the genitourinaty tract. Yes, there is such a thing as urogenital Tb as well as Tb meningitis, Tb of the bone (Pott's disease-spine), Tuberculous ulcers and abscesses, Tb pleurisy, and the list goes on and on. But what has marked me the most so far is Tb of the lining outside the heart called Tb pericarditis.
I met a young man who looked really sick. While examining him, his heart sounds weren't loud enough so I got an chest x-ray (below). His heart was huge and globular (water-bottle heart), which is characteristic of a heart with fluid in its pericardium, a space surrounding it. In this case, the fluid resulted from the inflammation that Tb was causing in the pericardium (Tb pericarditis). Sometimes, this fluid can accumulate such that it prevents the heart from filling and pumping blood properly. This condition is called cardiac tamponade and is a medical emergency. Fortunately, our patient didn't have that although he did have a lot of fluid around his heart.

Water bottle heart in pleural effusions

My patient had other symptoms such as profuse sweating especially at night-time (night sweats) and weight loss, but he was also suffering from HIV/AIDS. The plan was to start him on Tb meds, a painful 6 month course of multiple antibiotics all in a special cocktail with varying side effects. With good compliance, most people are completely cured, but that's when they are relatively healthy. The picture can be complicated by co-morbidities such as HIV and diabetes; these can and usually worsen the outcome. 
As for me, my journey continues as I unravel more and more Tb mysteries and discoveries. Wish me luck...

Threat to the health...EBOLA!!!

After practising for almost 3 years as a physician, I've learnt that medicine isn't this sure thing that medical school painted it to be. You know, it's not always getting the history, running the labs and getting a diagnosis with a clear management plan. I've been exposed to cases that were interesting yet challenging and choosing managements that eventually led to positive outcomes was a great learning and fulfilling experience. However, I was also faced with the reality that things don’t always go smoothly as I witnessed tragic deaths despite relentless efforts.
There were times when defined treatment plans couldn’t be executed due to patients’ limited funds. And there were times when I was clueless in front of an unknown disease. These cases were equally engaging and educative as I was expected to provide a solution as well. My greatest satisfaction nevertheless, was to see my patients leave the hospital happy.
And now I realise that there are times when you may have to choose between life and death. I'm practically surrounded by the deadly Ebola virus, and everyday when I wake up in the morning I have to ask myself: what would I do if an Ebola patient was admitted on my ward? Would I scram and never come back or would I put on the armor of courage (the protective gear) and care for my patient? I must be honest and say that I'm still struggling with this decision.

Update (Sep 26th):
Word has it (and from a reliable source too) that ebola has been contained in Nigeria. Nigeria is our next door neighbor so to say that this has been quite a scare is an understatement. Does this call for jubilation then? I don't know. And I don't think so. How can one jubilate when hundreds are still dying in Sierra Leone...in the Democratic Rep of Congo...in Liberia...in Guinea. I'm not a skeptic, and I'm not pessimistic either, but what a grim outlook for the motherland. Africa is still bleeding!!!

Courtesy of the Huffington Post (Seyllou/AFP/Getty Images)

Charity begins at home

01:00 am or so...

http://www.bridgetgongol.com/2013/09/the-truth-about-vaccines.html

It was just another one of those calls- hectic! Tens of children pouring in... near-death states. Often, I would just look at the parents, words beyond me, and I'd just shake my head. Best to save the adrenaline rush for something more worthy... like saving a human life.
So it was a night like any other; the ER, flooded with kids on transfusions. Little suckers! Vampires! Malaria, the smooth murderer, had not claimed any lives yet. But I was tired. Yes, above and beyond measure for I'd been working since morning... in this same surrounding.
So I was going to inform my colleague that for the next 3 hours she shouldn't bother looking for me. That I needed to re-charge my batteries or pretend to do so at least. I found her performing a lumbar tap on a 2-month baby. I got inquisitive, obviously. The babe had seizures so she was looking for a possible infection (maybe meningitis). I stood there for a while observing her. After all, she was my senior, a resident pediatrician; I certainly couldn't demonstrate lack of interest. But since she only managed to get a drop of the csf, cerebrospinal fluid (which strangely, was semi-solid), I decided to take my leave.

Cerebrospinal fluid

Only 2 min later in bed, did I realize that my bladder would overflow if I didn't rush to the nearest restroom. Another gymnastics at 1am, but on my way back, I waltzed by the lab where I saw my resident. Somehow, she'd managed to get that one drop of csf on the microscope, and wanted me to take a look. What I saw looked like numerous white blood cells and the reason I knew this was because she told me so. What I did know however, was that this showed that our baby had meningitis since normally, there shouldn't be this many cells in the csf. This made my night!!! Forget all the hemolysing, anemic, blood-sucking creatures in there. I had diagnosed meningitis for the first time just by looking into a microscope...and with a drop of csf. Of course, my badass resident had done all the work. I just came in to learn.

Meningitis   source: http://www.soc.ucsb.edu

Some more csf was collected and sent for further analysis. By morning, we'd found the incriminating germ - Haemophilus influenzae!!! A bacteria responsible for serious infections in children such as pneumonia, meningitis, throat, ear and eye infections, etc. The germ is covered by routine vaccination for babies at ages 6, 10 and 14 weeks and IT IS FREE in Cameroon. The mama confessed that she'd forgotten to take her baby for his 6 week vaccines, which again, made me look at a parent and shake my head. I think she deserved a spanking, but a very sick baby was punishment enough.

Haemophilus influenzae  (CDC Website PHIL Photo ID# 1946)

We put our patient on heavy dose antibiotics and steroids, and scheduled him for the vaccines he had missed. I managed to get my gazillion patients out of the ER, in one piece. No wonder I felt like I'd been run over by a bus. What a call!

Parents please, VACCINATE your children!!! It saves lives.

The Smooth Murderer

"The smooth killer. The smooth murderer...that smothers...that's what I call her. She doesn't fool around. She takes life in no time...if you let her."

In the 5 months or so that I've worked at my current job there's a unanimous consensus as to whom the  number 1 killer is. And if patients don't die they often acquire long-lasting sequelae, which will mark their lives forever. 
I'll never forget the day when a woman carried into the ER a 2-year old girl. I quickly examined the child, and from then on it was complete chaos. She was extremely pale (had little blood). Her extremities were cold and her pulse was weak. She was in shock. I began running all over with the parents to get her a blood transfusion, a fairly straight-forward process...most of the time. Once in a while, the blood bank may run out so parents have to search for blood elsewhere or you may have to wait a while for the hospital to restock from the neighboring medical institution. In other words, it's a matter of luck or grace (as we Christians like to call it).

So I finished making arrangements for my patient's blood transfusion and was watching over her. I wasn't exactly calm because she was already unconscious but I knew her blood would be there in no time and would save her. So I turned to something else for a few minutes only for my colleague to call me. The girl had stopped breathing. Let me tell you how I sprinted to the lab to inquire about the blood. No, I can't because I myself don't even know how I did it. And the blood was right there; it was served. So I rushed back to the ER but she was gone!!! I had blood but where was life? My heart skipped a beat. And at the same time, the blood smear results came in. She had a thunderstorm...of MALARIA. The smooth murderer had struck again.


To be continued...