Adventures in Paediatrics

Abasi had his mum and sister to visit recently. His sister had a few struggles at school in the early years but since changing schools had faired better. Abasi had always promised her that if she did well at school he would buy her a plane ticket to Dar. She had never been on a plane but it was something she had always wanted to do. She had done well in her December and March exams so Abasi surprised her with a flight to Dar. Abasi and his mum escorted her to the airport and Abasi helped her through security. At first the security personnel were reluctant to let Abasi through to help his sister. They asked for id and when he showed them his doctors id they let him through as he wrote “without a problem and with respect. I felt really happy!”

And so to “Adventures in Paediatrics”. In Abasi’s own words…

“Last time I wrote to you I just started working at the general paediatrics unit. Well things were not easy at that ward. The first time I was first on call (for the whole paeds department) I had a couple of admissions. Most of them were the usual routine admissions. Everything was fine until 6:30 am when I received two challenging patients who needed immediate help. One of them was a Sickler in crisis that needed my immediate attention with very low blood count(anaemic), while the other one was a cerebral palsy individual with rapid chronic convulsions, a high grade fever and very pale (he was anaemic too). I gave him phenobarbital injection as rectal diazepam while asking his mother to go and pay for a Full Blood Picture(FBP) investigation. She was panicking and all of my nurses attending are elderly, so I took the money and ran about 100m to the cashier, paid for samples, ran back to the ward, drew samples from both children then ran to the lab(about 150 metres) with the samples to do an emergency FBP and cross match, waited there till till I got the blood then ran with it to the ward,and gave it to the nurses for infussion. At that time everyone was waiting for me to present all of my cases at the morning meeting, so I didn’t have time to write anything about the last two patients other than what was in my head.

I presented my cases for the first time thinking that my superiors would be impressed. I can’t forget that day as one of the paediatricians made me sweat plasma. She was so tough on me, judging every sentence I said, no believing anything I said. She said I mismanaged all the patients that came that night. She asked why I didn’t document the two patients who came earlier that morning. I had to explain to her the scenario and told her that I managed to stabilized all the patients before I came to the meeting and they were doing fine. I also left instruction with the nurses on what to do if the convulsions recurred. She didn’t believe that either so rejected everything I said. I felt really bad in front of other specialists, interns and nurses, so I kept quiet. She also told me to go along with her to see the patients. As soon as we were in the ward, my patient had another episode of convulsions and a nurse was giving her a maintenance dossage of phenobarbital, so the “mean specialist” started blaming me. Why did I leave? I told her the patient was stable and not showing any sign of getting another convulsion episode and it was obvious the convulsions reccured after two hours as we were done with morning report.

She talked to the mother and found out that there was a single piece of information that I missed about child’s illness when he was three- years old. You can imagine what followed (the child was 11 year old by then). I kept quiet till she finished talking,because she was stubborn. What I found out later was that she was pregnant (hoooòoooooooo …exhaling deeply). I took her to review every patient I admited that night, showing her I was stubborn too. Every time she wanted to go, I told her there was another patient she should review. She got tired but I insisted she review all my patients as she didn’t believe my management decisions. Obviously she got tired as I had many admissions, so she left at last really tired and I was smiling.

I though it was over, but the next day the head of department called for me. I went to see him and found that he was very angry. He told me that they were punishing me by adding three more weeks to my rotation. I was shocked, so I asked his permission to speak freely. I explained to him the scenario step by step as he wasn’t at the morning meeting. He then decided to go to the patient for second opinion and to nurses who were on call with me that night for third opinion. He came to realise that I did my best and I was right. yeaaaaaaaaaaaaaaaaaaah……

So he told me it was not right for them to add three weeks so instead he gave me one week for missing information about that patients illness when he was three years old (there were no record’s back then). I accepted it thought I could see in his eyes that he knew it wasn’t fair as I managed to gather a lot of information when the patient was in distress and the mother was panicking while I was stabilizing that patient and all the information was in my head. He knew that if I went back the second time which is the protocol, I wouldn’t have missed anything so he gave me a week instead of three to make peace with the other specialists.

Everyone started calling me “abasi mawiki” as in weeks in English! I told them that in two weeks every specialists including her will be my friend. They didn’t believe me as they were in the department much longer than me and they usually avoid the “mean specialist”. Time passed and I thank God everyone started seeing my potential for managing patients, when I helped IT staff during meetings, when I fixed my superiors PCs, the way I talked to nurses and to be honest all were my friends. Nurses loved the way I worked with them and the way I respected them, calling them “mama” as they are my mother’s age, so things started turning around.

After three weeks I shifted to the Diarrhoea ward for two weeks and the specialist over there is a friend of mine. Everytime she arrives she asks for me, we talk about a lot of things at length. She was sharing her knowledge and she would listen to and appreciate what I had to say. She talked about her children, her masters study in China and joked with me as if we are on the same level. She commented on my presentation to other doctors and even the head of department, who is her husband, was impressed.

When my theee weeks were finished I moved to the malnutrition, HIV and TB ward, which receives most of the patients who are in a special program funded by the Texas children’s hospitals, abort fund and Baylor hospital. They have their office and branch here. So we have ward rounds with a lot of white doctors from America working here for charity. We usually have interesting major ward rounds on Mondays and Fridays. I am still in this ward for one more week and later I will do my final (bonus punishment week) at Baylor hospital here in our facility.

The “mean specialist” is now very friendly with me and she never doubts me now and she hasn’t shouted at me even once in all the service ward rounds or in any of the major ward rounds. A few days ago when I was in the cafeteria she came and found me eating so she told her husband (who is also a specialist of internal medicine ) to come sit with me. I was surprised, and we talked a lot until we both had to go back to our jobs. She is not mean any more and I like working with her.

Mission Accomplished…”

I think Abasi should have been a politician.