Day 61 and 62: How i did my first amputation

We cancelled our cases today because our house refused to submit operation list to peri-operative nurse, orthopaedic ward and anaesthesia department.

My boss gave me query and gave the house officer a week extension in orthopaedics.

It is not easy to be a leader.

We reschedule the surgery to the following day.

This morning I did a quick revision of amputation, hoping my consultant will allow me to do the surgery.

Thank God, after some begging and proof of my capability to handle the case he oblige me.

Well it went well and I am very happy I was able to do the amputation successfully.

I made two equal anterior and posterior skin flaps at about 12cm proximal to the knee joint. I expected the skin to retract proximally and so it did. I cut the fascia just at edge of the retracted skin to expose the thigh muscles. I then raise my muscle flap at the cut edge of the fascia. However, on the medial side I have to dissect the muscles layer by layer to avoid cutting the big vessels. I identified the sciatic nerve, retract it upward and cut. I separated the femoral artery from vein clamped, tied and cut.

I exposed the femoral bone by pushing the soft tissues upward and then saw off the bone. I chiselled off the edge and then closed each flap layer by layer.

I hope I have a wonderful postoperative period.

Day 60: Pleomorphic sarcoma of right leg soft tissue with tibia invasion

After Sunday service today, I went to Bucky’s (my paranoid friend) house to return her iron bowl with which she prepared my chicken the other day. She called me twice to request for the bowl but what I could deduce was that she was more interested in seeing me.

Arsenal seems to be flying now and we once again struggle to win our match. As I said the season is beyond us and if we win, it will be because of other clubs undoing.

I called my house officer to ensure the preparation of the two cases we intend to operate on tomorrow. First case is pleomorphic sarcoma of right leg soft tissue with tibia invasion; we plan to do above knee amputation. The second is a case of multiply injured patient who sustained fracture of femoral shaft, neck and tibia plateaus; our plan is to do open reduction and internal fixation.

I received another two visitors from home today. We are now four in my house.

Day 59: I really which club like villa and spurs can take the initiative

I am happy Chelsea draw today but I would have been happier if they lost that match because they did not deserve to draw.

This season is somehow, it is as if all the big four are passing through poor spell period. I really which club like villa and spurs can take the initiative. Well, I have a feeling Manchester united will win the league though the league is for Chelsea to lose. I pray we win our match tomorrow because nowadays you cannot really be too sure.

I could not wait to finish watching Liverpool match, I later learnt they won by two goals margin.

One of my cousins left today.

I got home around 8pm and unfortunately, there was nothing at home for me to eat. I have to drink garri with chicken (garri is a form of cassava flour but not refine).

I watched surrogates today before I went to bed.

Day 57 and 58: Merry christmas and happy new year in advance

Thursday

I woke up so late this money. Thank God today is public holiday because I would have not been able to bring my self up if it had been normal working day.

I went to see my paranoid friend today. She is on duty; she works at our computer department.
I told her she has multiple personality disorder stimulated by ex boyfriend who broke her heart.
I asked her if she might want to come to my place today but she told me she would be going out with one her neighbors.

One of my cousins came to visit me today from Akure. He just finished his degree program at federal university of technology Akure.

Sekemi came to help me cook stew and vegetable soup to entertain my visitors against tomorrow.

Friday

Today is Christmas and I have made up my mind not to travel. I believe I am old enough to receive and entertain visit on Christmas day.

Many people came to house today and after an elaborate meal and we discussed about football, national and hospital politics.

My paranoid friend showed up with another friend of mine who she claimed to be her cousin. For the first time I did not step of my house today.
Sekemi accused me of dating a nurse who helped me bought fowl from hospital cooperative market.

The girl is highly obsessive and I do not even know if it is an advantage to our relationship or not, but sometime, I felt she was taken it too far.

Day 56: She is so paranoid about having an affair with a medical doctor

As the Christmas and New Year approach, many of our patients refused to come to clinic.

We only saw about 10 to 15 old cases, 2 new cases and 4 emergency cases this morning.

Tomorrow and Friday have been declared public holiday by federal government. As a result, we did a quick ward round after our clinic.

I asked someone to help me get a fowl in my hospital cooperative market but before I could get home, I noticed it has stopped breathing.

I went to a woman’s house today; she is so paranoid about having an affair with a medical doctor. She said doctors are liars andwomanizer. Is there any man who does not like beautiful woman?

I do not even know what to do about her, she is an extra ordinary woman and I, with all my experience with women, felt some thing different about this one.

She refused to come my place this evening and I begged her to help me with dead fowl. She told me she could not visit a guy who came to her house for the first time. She told me to drop the fowl and she would help to tidy it up at her place but she would not come to my house.

Well, I eventually left for my house around 8:30pm after enough persuasion.

Day 55: His Pack Cell Volume came out to be 20%

Today is my round and association of resident doctors are having their election.

The skin grafting I did last week failed to take and the patient refused repeat skin grafting.

We had four patients over the weekend with one of in bad shape. His Pack Cell Volume came out to be around 20% and needed to be transfused with two unit of fresh whole blood.

He was multiply injured patient who has fracture of right radius and ulna, communnated mid shaft fracture of the left femur, displaced fractured neck of head of femur and fracture of left tibia plateau.

We planned to take him to theatre for open reduction and internal fixation as soon as he stable for surgery.

All the candidates I voted for lost in today’s election. I left for my house in a sober mood.

Day 50 to Day 54

Usually my diary is the last thing I do for the day, but because of lack of internet service where I stay, so I blog it the following day. That was why it appeared late most of the time except when I am on call.

As I said about five days ago, I was not in town in the last few days because I went to a friend wedding ceremony.

I travelled a long a distant across another geopolitical zone to attend the ceremony. In Nigeria, we have six geopolitical zones. I reside in southwest zone and I travelled to north central zone.

By the time, I came back on Monday I could not even take my bath let alone write my diary.
The ceremony was very eventful though I could not get any new female friend number. I think I am becoming more satisfied with Sekemi.

Last weekend was bad for my club and I cannot remember the last time we lost with that kind of margin without scoring a goal, probably against Milan in champion league semi 2007 at San siro. I learnt we are meeting them again next year; God help us. Well, Chelsea and Liverpool having bad results too limited the damage.

The end of the year is fast approaching and I cannot see one significant thing I have done. I hope and pray next year is different.

Day 49: I am reading anatomy first

Christmas is fast approaching and usually most patient in this part of the world prefers not to have their surgery during this period. In fact, nobody wants to be admitted for now. Because of this, our clinic was very light today. By 1pm, we were through with our clinic.



I have started reading for my primary examination in surgery. I am reading anatomy first. I spent most of my remaining time today at library. I went home around 7pm.



I am happy Chelsea faltered this evening though they were able to win via a controversial penalty. Arsenal surprisingly drew their match and Liverpool undeservedly won today.



Diary, this is going to be my last daily write up for the week. I am going to a doctor’s friend wedding ceremony. The place is very far, about 6 to 7 hours drive. The event will take at least 3 days from me and there is no internet facility where we are going. I will see you on Sunday.

Day 48: Nurses here in Nigeria are more interested in fighting doctors than helping them.

Today is my ward round but before we could start the round, the Chief Nursing Officer of male orthopaedic ward called to inform me of one of our patients that was gasping for breath. I reviewed and immediately commence on intranasal oxygen, Intravenous Fluid and I have to pass NG tube for feeding.

Our ICU no longer functions and in this hospital, you have to solve most problems yourself or your patient will die before the unit you call comes to review the patient.
In addition, to make matter worst most of our nurses are incompetent and are more interested in fighting doctors than helping them.

I make up mind today to do my residency in surgery (orthopaedics) rather than Obstetric and gynaecology. I am falling in love with orthopaedic surgery.

My cooking gas got finished yesterday, I send a doctor friend to help refill my cylinder against tomorrow at Akure. There is no gas station in Owo. I have to eat out tonight.

I got home around after 7pm and settle down to enjoy our match. I will have to say the match was boring though I was able to stay glue until the final whistle was blown before I went bed.

Day 47: I am on call

My consultant asked me to do the skin grafting while he would take the amputation.
Of course, I have not done it before but fortunately, for me the plastic team were around in the theatre. I have to beg the plastic surgeon to release one of their registrars to assist me.

After the surgery, I went to doctors’ common room to write financial report of our health week programme last week.

My house officer called to inform me of the demise of the post-amputated patient following pulmonary embolism. She died some hours after the repeat amputation.

I am on call today, so I have to stay over the night. I asked Sekemi to call DSTV man to help solve the problem with my HiTv and DSTV. She later told me the problem have been rectified.

My call has been peaceful so far.

Day 46: First patient is a case of peripheral vascular disease

I came to hospital this morning to prepare three of my patients for surgery against tomorrow.



First patient is a case of peripheral vascular disease following diabetic foot. While the second case is an old wound, which has refused to heal after an amputation in a 70-year-old woman who was involved in a road traffic accident.



We planned to do above knee amputation and skin graft respectively.



I was however informed that the anaesthetist cancelled the third case because he was not fit surgery.



Though I prayed for draw in today’s match between Liverpool vs. Arsenal, I am happy Arsenal won the match.



My satellite TV refused to work again after the match. I really wish this is not a serious problem. I will have to see the DSTV man tomorrow.

Day 39 to 45: Health week and Humanitarian Service

Diary I am sorry I have little or no time to write my daily activities. It was a hectic week for me and I could not just do any other thing. Thank God, I am back and health week programme is now behind me.



Last seven days were days I was truly proud to be a doctor in Africa. I was able to give back to the communities that have spent so much to train me. We were able to cover six communities where free drugs, health education and free consultation were provided.



We were unlucky; we should have gotten at least a point today. Well, the good news is that Chelsea drew their match against Everton.

I hope for draw tomorrow between Liverpool and Arsenal.

Day 37 and 38

Friday is always my favourite day. We were able to arrange 11 doctors to each centre with one of them acting as a team leader. I know most of our volunteer doctor can still change their mind, so we ask each team leader to walk on their member and make sure they show up on Tuesday for the outreach.

The chairperson of the committee travelled to Lagos today to buy glucometer and strips, which we will use to do random blood sugar during the programme.

Sekemi came to my house later in the day but she refused to help me cook anything. She told me I am having an affair with another woman and that I should let her go her own way. Woman can lie; she talked as if she really wants to leave me. She was only interested in blackmailing me to abandon all other women in my life.

I eventually cooked indomie nodules for dinner when I could not convince her to help me with something.


Today (Saturday) was a great day and it was marvellous in Manchester united fans.
I started today by acquiring a viewing centre where you can watch premiership and other league matches. I really hope I can make some extra money from this.

We won our match today with a big margin and tantalisingly Chelsea and Liverpool lost and drew respectively. What a wonderful day. We are now 2 point behind the league leader despite our long injury list.

After the match, I went to see Sekemi who no more think ill of me.

Day 36: Preparation

I am officially not working for now because of our health week preparation.
I met with Obas and chiefs to finalise how the programme will be held in their various communities.

I learnt that our president in this country is ill and he had to be flown to Saudi Arabia for proper medical management. Sometime I feel very low as a Nigerian and obviously, this is one of those periods. Our hospitals here are glorious health centre with little or no facility and with little take home pay for doctors. We cannot even boast of one world standard hospital.

I am having malaria symptoms; I went home early after my journey to treat myself.

Day 34 and 35

Preparation for the humanitarian programme taken place next week had consumed most of my time yesterday and today.

I thank God my consultant is not around or else i would have not been able cope with work load.



I travelled to Akure to buy drugs and materials to be used for our free health programme.



Today we went to the six communities that will benefit from our free health programme.



I am so tired and I need to go and sleep.

Day 33: Our health week is starting next week

My consultant is not in town. Therefore, we did not prepare any patient for surgery.

We did a general ward round and we agree that the diabetic foot patient will benefit from above knee amputation. We will have to inform Dr. Adeitan, the surgeon deputising for my boss to assist us.



I have been able to convince my cousin friend to sponsor our community outreach programme. He gave us eight hundred thousand naira (around $5000). I am going to be very busy this week. Our health week is starting next Monday.



I had an emergency meeting with executives of Association of Residency Doctors. I told them about the money I was given and we discussed how it should be spent.



We later had general meeting of the association where we finalised most of the plans for the programme.



I watched prestige before I slept.

Day 30, 31 and 32

I was in the hospital early on Friday morning to see the patient I did wound debridement for his legs. The smelling had significantly reduced and he is improving though the medical team are still battling to control his blood sugar.



I spent the rest of day watching movies in my house.



I decided to stay in door throughout Saturday but after spending some hours sleeping and reading, I went to Akure to visit madam speaker.



I am happy we won today’s match after initial scare by Pompey. The penalty given to Pompey was the worst I have seen in a long time. Is as if the referees are out to punish us. Of course, I know Chelsea will win tomorrow.



I came back from Akure today. I got home around 3pm.

I have two important matches to watch today. One is el-classico between Real Madrid and Barcelona and the other is a derby between Arsenal and Chelsea.



Chelsea was too strong for Arsenal to handle and Pellegrini made a tactical error by substituting Ronaldo. I would have loved arsenal and real Madrid to win.



Tomorrow is another Monday and work surely will start tomorrow after four-day holidays.

Day 29: She asked me in a derogatory way

I got to theatre around 10am and I was immediately confronted by the most senior peri-operative nurse; she wanted to know if could handle the case. She asked me in a derogatory way. I of course did not answer her but referred her to the registrar in my unit.

We started the case around 12 noon and by this time, the whole theatre smelt of gangrenous tissue. More than 70% of the right foot is gone while the whole of little toe of left foot was already auto amputated. After removing as much as possible dead tissues, I tried linking all the sinuses together then wash with hydrogen peroxide and copiously irrigate with normal saline. Surprisingly there were bleeders on the exposed deeper tissues. I dressed with gauze and crepe bandage then informed the nurses to commence on daily wound dressing with honey and continue present antibiotics. We also asked the medical team to ensure well control blood sugar.

I spent the remaining part of today working on the net and reading. Sekemi called to apologise and my patient girlfriend, Toyosi called me today to know when she should come to visit me.

I got home around 7pm and I watched star trek, Madagascar, and terminator salvation before I slept. Remember I have an off day tomorrow.

Day 28: I told him the man would need amputation

Sometime I wonder why Alex Ferguson refuses to retired as coach of Manchester united. To me, the man is now more of problem than solution. He could decide to lose a match by choosing to field a weakened team without considering the fans. What I know is you field your strongest team, and then when you are comfortably ahead you can bring in your young and inexperience players.



Federal government declared Thursday and Friday as public holidays for Muslim festive period. Today is our last working day of the week. My unit is on call so I cannot travel, though I am not on call but my consultant asked me to stick around being the most experienced in the unit.



My boss called me around 4pm after the clinic to meet him in his office. He told me to go to the theatre to do the extensive wound debridement of the diabetic foot we admitted on Tuesday. Of course, I told him the man would need amputation. I eventually cancelled the case and reschedule it until tomorrow morning because of lack ambulance to carry the patient from the ward to theatre.



Sekemi and I had a fight today because of her perennial excuse that her mother would not allow her to stay with me. I went to sleep thinking about the procedure I am to do tomorrow morning.

Day 27: Twelve passengers died and were taken to the morgue

We now have eighteen new cases; all of them having multiple fractures of the limbs. There was a head on collision between 18 sitter bus and luxurious bus along Owo and Akure road. Twelve passengers died and were taken to the morgue. Most of these people are yet to contact their relatives.

My consultant asked me to contact social welfare services on their behalf and see if we could help anyone before their relatives come.

My boss joined me in my ward round today because of these new patients we admitted. Most of these patients require urgent surgery but because of financial constraint, we could not take them to the theatre. My consultant did everything possible to assist them but there just too many.

I have not slept in the last 24 hours and I had reached a point where I might break down. Thank God, I am not on call today.

After it was certain that none of the patients would be ready for surgery today, I left for my house around 7pm to have a cold bath and good night rest.

Day 26: He threatened to issue them query

I got to theatre early today and surprisingly my consultant came to the theatre around 8am. I was the only doctor in the unit that was there. My boss was so annoyed that he told other doctors in the unit to go back home. He threatened to issue them query.
I personally do not want them to go home because I cannot do the work alone. They were later allowed to report back after someone begged on their behalf.

We had three cases today. First patient is a day case who came for removal of inter-medullary nail of the right femur. Our second case is that of 37-year-old male who had segmental fracture of left tibia with malunited lower fracture line and non-united upper fracture. We initially wanted to insert interlocking nail but we have to abandon procedure and instead reduced with plate and screw.

The last patient is that of chronic osteomyelitis that we did seqestrectomy on left femur. We left theatre around 3pm. I am on call, so I could not going home.

I was invited to review a case of septic arthritis in a 2-year boy. I placed him on intravenous antibiotic after arthracentensis.

I also saw a case of diabetic foot today. The patient leg has to be amputated and unfortunate for him both leg are affected. My consultant is thinking of saving both legs. However, as for me I think the earlier the better.

Day 25: How could Wigan allow this to happen?

I learnt this morning that Tottenham defeated Wigan 9 goals to one. This is the heaviest I have seen in a long time in any competition. How could Wigan allow this to happen?



I got to know that most goals scored in a single premiership game was between Portsmouth and reading during 2007/2008 season, Pompey defeated reading 7 goals to 4. While the highest goal margin was between Manchester united and Ipswich in 1995 when the score was nine goals to nothing.



I could not go anywhere this morning because of the lady friend of my friend in my house. I had to wait for my friend to come before I could go out around 4pm.



I came to hospital to update my diary and see my patients who we are preparing for surgery tomorrow. I had to make sure all the necessary materials like orthopaedic packs and blood are ready for each patient or else we will not take their case tomorrow.



Sekemi later called me and told me she was waiting for me at home. By the time I got home, she had prepared fried yam with egg for me.



I was able to finish watching “public enemy” and “state of play” before I went to bed.

Day 24: Some time I think we men take it too far

I went to the hospital this morning to update my diary and did some other work on the internet. I can only access internet in the hospital. Today was full for me but not that eventful.

I have three football matches to watch one after the other and I must say I am very happy with the results of all the matches except that of Chelsea. Well I did not expect wolves to defeat Chelsea anyway. I am beginning to have confidence in our team and I am more than happy with our display today against Everton.

Aside football I would say today did not go the way I expected it to be. Sekemi was supposed come today after her lecture but she was no were to be found. She called me later to give me one stupid and lame excuse on the reason why she could not make it. I would say I have never seen myself got that angry on the phone. Probably women think that we men are idiot.

A friend of mine was in trouble today and had to call me to rescue him. His fiancée called to inform him she would be spending the night with him when he was in fact with another girl of his. Therefore, the girl had to come and sleep in my place. Some time I think we men take it too far.

I finished the remaining part of '' Harry Porter'' and I even watched about an hour of ''public enemy'' before I slept.

Day 23: What A Country

I went this morning to surgery weekly presentation about HIV/ AIDS in Surgery. Around 16 minute past 10am, my consultant gave me a signal for us to go and start our round.

Our round was business like today. No question was asked, probably my boss want to get out of town fast. We were through with the ward round around noon despite the fact that we saw all patients in the department. We are to prepare three patients for surgery on Monday.

Diary, I told you yesterday how much tired I am of this country. This morning I was going through some dailies and what I saw made me to be ashamed of my country.

"The budget presentation is one of the most important, if not the most important event in the life of any government and any nation. Apart from being a national event, which gives all Nigerians indication of how their welfare will be taken care of by the government, it is also of international significance since it is a major gauge by which trading partners and investors will determine their attitudes and relationships with Nigeria in the coming year."

However, to my surprise the senators and House of Representatives are fighting about whose chambers should host the joint presentation.

"Nigerian federal lawmakers are perhaps the best paid in the world, yet they are turning out to be the least productive. The only time people hear their voices are when they are involved in one scandal or another or when they are haggling over their disproportionate perks."

We all know what happened about three days ago when the Queen presented her annual address; the House of Lords is a much smaller chamber but everybody, including the much larger House of Commons had to come to the House of Lords and everybody stood up until the presentation was made.

I really hope they come to their senses and allow this presentation before the end of this year.

My patient girlfriend finally left today.

I got home around 7pm. I cooked nodules and had cold shower. I watched about thirty minutes of harry potter and the half blood prince before sleep kicked in .

My quotes are from Nigeria guardian daily newspaper.

Day 22: I am Tired Of This Country

Today and Tuesday are usually less busy if my unit is not on call. I came early today hoping to do some work on my computer but unfortunately, there was no power supply in the hospital and no internet service. I have to wait for some time before we could start our round.

Well, to my relieve and that of others in the ward we discharged my patient girlfriend home and she is to see us back in two week in the clinic. She told me she would not go until tomorrow.

However, the other patient with acetabular fracture cannot afford to pay for instruments to use for the transfemoral skeletal traction.

An old girlfriend decided to stage a come back on phone today. Well, I think I am in love with Sekemi now. I am confused what should I do?

I decided to stay over to do some work on the net but service is very slow. I eventually was frustrated and left for my house.

Taxi increased their transport fare today because of fuel scarcity. I am tired of this country. No good road, epileptic power supply, poor health care delivery and the only thing God bless us with; we are also made to suffer for it.

Day 21: She Is To Have Transfemoral Skeletal Traction

I woke up today by phone call from a female friend at Akure. She said she is coming to visit me today and asked if I would be available. Of course, I will be at work but I told her she could come. My consultant nearly quarries me when he saw her in my office. I have to lie that she is helping me with my computer that was faulty.

Today is usually very busy so I have to eat very well before coming. We admitted two patients for surgery next week Monday and we also admitted a case of 35-year-old woman with right transverse acetabular fracture. She is to have transfemoral skeletal traction. We saw more than 30 patients and about 7 new cases.

We finished our clinic around 3pm and my team went to see my consultant who had left before we could finish the clinic. I informed him of a case we admitted at accident and emergency whose x-ray features are suggestive of osteosarcoma of right Ilium. He told us to refer the patient to university college hospital, Ibadan where there are better facilities to handle this case.

I have to leave hospital immediately because of my visitor. She told me she was not happy because I never ask her out. Sometime I wonder why most women want to marry medical doctor. Well, I told her I do not want to break her heart and I am not yet ready for marriage.

My girl, Sekemi came to my house later in the day. She could not cook anything though she helped me with cleaning of my apartment. I ate corn flakes and milk before I could sleep.

Day 20: She Was Happy

I got to work 16 minute late today. Like I said before it is a common occurrence in this part of the world. It is sometime called ‘African time’. I personally try as much as possible not come late to work.


Today is my ward round. The round has started even before I got there. I discovered that my house officers could not manage malaria. It took me much time to teach them how to manage malaria. If you do not know how to manage malaria as an African doctor then you do not know anything.

I decided to go to my girl’s house after 2 days of cold war. She was happy; she thought she had lost me. I told her she is too selfish and obsessive. She told me I am a liar and womanizer. Well, she apologised and we had a truce but she still refused to follow me home.

I could not eat bread tonight again because I am having constipation. I had to eat rice
with stew.

Day 19: I do not think I can cope with this loneliness any longer

Our first case in the theatre was that of 65 year retired man who sustained injury to the right knee following a fall on account of domestic accident. A diagnosis of transverse patella fracture was made after necessary investigations. Patient was planned for open reduction and internal fixation with tension bound wire.

An attempt to reduce the fracture with bone clamp further fracture the distal fragment because of osteoporotic nature of the bone. And by the time we eventually finished we spent more than necessary time on this case.

The second case is that of 60-year-old man with recurrent discharge from multiple sinuses on the left thigh and after necessary investigations, a diagnosis of chronic osteomyelitis of the left femur was made and we planned the patient for sequestrectomy and incision and drainage because of associated pyomyositis. And by the time we finished for the day it was already pass 2pm. Thank God our third case discharged himself against medical advice.

My girlfriend is still fighting me and my patient is not talking to me either.
I do not think I can cope with this loneliness any longer. I left hospital around 7:30pm and branch to buy bread along my way home.

Before I could sleep I was able watched ‘body of evidence’, a movies casting Morgan Freeman and Gene Hackman.

Day 18: He Has Osteosarcoma Of Left Tibia

Today is Sunday, the lord’s day. My girlfriend woke me up with her continuous nagging about how her mother will talk to her harshly for coming to my house. She told me only her stepfather allowed her to come. So I spent the whole morning consoling and reassuring her.



I came to hospital afterward to do some reading and see my patients. Tomorrow is our theatre day and I have to make sure all our patients for surgery tomorrow are ready. We have three patients for surgery and one of them I learnt had discharged himself against medical advice because we told him he would need amputation. He has osteosarcoma of left tibia.



I am happy we lost today against Swiss in the final under 17-world cup. Those guys are too old to play under 17. On the other hand, I was told that other countries falsify age too. Most Nigerians believe others do it too. I stopped watching the match before the final whistle.



I bought some beans cake to eat before I sleep. Bachelor is suffering oh.

Day 17: Nigeria Qualifies For World Cup 2010

My friend who is also a doctor got married today. The ceremony took place at Akure, a town about 45 minute drive from where I work and reside. All Nigeria major roads are bad because ordinarily the journey should not have taken up to that.



Many medical doctors were there and we really had a nice time. Doctors normally do not have social life and once a while if opportunity presents itself we make sure we do not waste it.



Well, Nigeria has wobbled their way to world cup 2010. I do not know how it possibly happened but we did it. I am not even sure if it worth it, because we will not defeat any serious team in the competition.



Do not see me as non-patriotic person, my heart has been broken many time by the attitude of super eagles to serious competition like this.



My girlfriend accused me of my frequent visit to my patient friend and I told her there is nothing between us and surprisingly my patient also accused me of abandoning her because of my girlfriend. I like her courage she wont take no for an answer.



My girl agreed to sleep in my house today. I think I will definitely have good night rest.

Day 16: I Have To Frustrate Him From Presenting The Topic

I knew today will be very busy immediately when my consultant told me we will see all patients in the department.

We started today’s work by attending surgery resident presentation and we did not start our grand round until around 10:30am. By the time we saw our last patient we have spent 6 hours standing.

Moreover, to make matter worse one of the resident wants us to wait for his presentation. I have to frustrate him from presenting the topic.

I spent some time with one of my female friends gossiping about noting important.
I left for home around 8pm and went to sleep without having my usually cold bath.

I was able to watch ‘the taking of Pelham 123’ before I finally sleep.

Day 15: We Lost A Gem

I lost a friend last week Friday and he was buried today. Most members of association resident doctor were supposed to be there.

However, we have already agreed to travel to state capital to see some of our sponsors today. We eventually divided ourselves into two groups; first group will go for burial ceremony while the smaller group will travel to the state capital.

I took permission from my consultant for the reason I stated above.
I would have loved to go with the first group but I was chosen be in other group.

I came back from Akure around 2pm, only to be told by my consultant that we have a case of crush injury and I should go and prepare patient for emergency wound exploration, extensive debridement and application of external fixator.

By the time I left theatre around 7pm I was completely tired.

Nigeria is playing Spain today and I could only watch some part of the match.
I started dozing when the score was 3-0 in favour of us. I have a feeling those boys are older than they claimed.

Day 14: Beautiful Day

Today’s work was surprisingly light and we only attended to 22 patients in our clinic. By 1pm, we stopped seeing patient.


I spent most part of today in the doctor’s common room, talking about Google adword, forex and affiliate programme. Of course, most of us do not know anything about these. But as for me, I think I have more than passing knowledge about them. All of them were surprised that I could spare so much time to know so much about non-medical stuffs.



My patient is seriously fighting me because I told her I already have a girlfriend. I cannot wait for her to be discharged because her case is already becoming an embarrassment to me in the female orthopaedic ward.



I asked a friend to help prepare vegetable soup and stew. She helped cooked rice to savour the soup. After eating, I went out with a friend who invited me for a party.

I later left because it was boring.



I call my girlfriend to come and sleep in my house but she refused because her parents will not allow such.



Well I went to sleep alone.

Day 13: We Work Alone

We have three unit and unfortunate for me the heads of the remaining units are not on ground. One is on annual leave and the other is away on conference. So all other units report to my consultant and their entire patient are now ours. Moreover, I now have more patients to manage.


Today is supposed to be my ward round but my consultant because of the reason stated above eventually hijacked it.


Most of our patients in accident and emergency have a habit of discharging themselves against medical advice. They end up at traditional bonesetter. Therefore, in real sense we admitted one third of our accident and emergency patients. However, they come back months later with fracture bone disease.


I went to library around 4pm to finish reading harry potter volume one. My patient girlfriend called me for an important discussion. Well there is nothing important, all she wants is my presence and I think it is high time I discouraged her.


I am now in my house and I think I should finish watching heroes before I sleep.

Day 12: I Think She is Seriously in Love With Me

We were supposed to operate on three cases but the last case, an elderly man with patella fracture declined surgery because of lack of money.

We started surgery around 10am, though we should have started since 8am. Our first case is a case of non-union of about 2 years duration. We did open reduction and internal fixation with plate and screw and bone grafting to bridge the gap of the non-united bone. I assisted the surgeon, we spent about an hour maintaining haemostasis, and by the time I closed the skin we have already spent more than 3 hours.

Our second case is an auto amputation and we want to refashion the stump. We amputated the exposed bone, freshen the edges, and closed the skin.

I eventually left the theatre around 4pm and went for AGM planning committee meeting where we were trying to put final changes to the up coming programme.
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My patient girlfriend wants a commitment from me and I think she is seriously in love with me.

I got home around 7pm.

Day 11: We were just unlucky

We were just unlucky. We played so well and even outplayed and outmuscled them.
Since I have been watching football this one of the few times I knew we did not deserve to lose. Moreover, the referee did not help matter. I know I had already predicted Chelsea would win but I am disappointed because they did not deserve it.

Around 4:30am this morning, my house officer phone call woke me up. She informed me about a patient in the accident and emergency that needs to be reviewed. When I heard the history of this patient I almost believe vampire exist, because I cannot understand how a normal human will bite a fellow human and completely shopped off all the soft tissues of its left ring finger. Well I later referred the patient to plastic surgeon for refashioning.

I learnt my new patient girlfriend was crying and needed to see me because nobody could keep her quiet. She told me her only friend in the ward died on account metastasis following breast cancer. Hospital is renovating surgical ward so some of their patients were transferred to orthopaedic ward. I asked my house officer to give her something to sleep.

Today is one of those days, you want to be left alone and that includes you diary.

Day 10: I think I am in serious trouble

We were just unlucky. We played so well and even outplayed and outmuscled them.
Since I have been watching football this one of the few times I knew we did not deserve to lose. Moreover, the referee did not help matter. I know I had already predicted Chelsea would win but I am disappointed because they did not deserve it.

Around 4:30am this morning, my house officer phone call woke me up. She informed me about a patient in the accident and emergency that needs to be reviewed. When I heard the history of this patient I almost believe vampire exist, because I cannot understand how a normal human will bite a fellow human and completely shopped off all the soft tissues of its left ring finger. Well I later referred the patient to plastic for refashioning.

I learnt my new patient girlfriend was crying and needed to see me because nobody could keep her quiet. She told me her only friend in the ward died on account metastasis following breast cancer. Hospital is renovating surgical ward so some of their patients were transferred to orthopaedic ward. I asked my house officer to give her something to sleep.

Today is one of those days, you want to be left alone and that includes you diary.

Day 9: Sometime I hate to be a doctor and this is surely one of those times.

My consultant is having his ward round today and he insisted I must be in the presentation by general surgery before we start. We eventually started our round by 10:30am. We have eight patients on admission and we were to prepare two of them for surgery on Monday.

My patient, the one I operated on is in love with me. And I honestly do not know what to do about it. She told me yesterday that today is her birthday and she said I must be there as her boyfriend.

I am still not fully recovered from fatigue of excess work I did yesterday. Immediately after the round, I went to call room to have a refreshing sleep.
A phone call woke me up and it was from my hot patient who will not let me rest. Sometime I hate to be a doctor and this is surely one of those times.

I got home around 6pm and I went to barb my hair before I return home to find one of my two girls waiting for me. She helped me prepared fried plantain and egg.
I went to sleep after watching part of season 4 of heroes.

Day 8: My First

I slept in the call room so I did not have the luxury of going home to change my clothes before our case in the theatre this morning.

My consultant is not coming, so he asked me to do the surgery been the oldest in the unit. I must tell you the truth I was scared because I have not done this kind of surgery before.

I have to insist on application of tourniquet to give me bloodless field to operate. Initially it was as if I was a born surgeon but eventually I ran into problem as expected. I could not remove one of screws and I have to be careful not to re-fracture the bone. However, after about 30 minutes of manipulation I was successful.

At end of everything, I was so tired that I have to use analgesia so that I can sleep.
A new resident from family medicine has been posted to our unit and I have to insist he should take today’s call.

I was embarrassed by the display of Everton against benfica today and I am happy Nigeria under 17 won New Zealand 5 goals to nothing.

What A Day!

We had clinic today, it is one of the busiest day in the week, and coupled with the fact I am on call, I know I have long day ahead.

I started seen patient by 9am while my consultant join me an hours later. The only time I could stand up to stretch my leg was around 7 hours later. To make matter worse there were no free space to admit patient. We could only admit three.
First patient is to have removal of plate and screw tomorrow and I was told I am to handle it. While the others are being prepared for major orthopaedic surgery on Monday.

While we were at the clinic, we had four consults from accident and emergency. We finished the clinic around 4pm and left to review our emergency cases.
One had claviclar fracture, while the others presented with knee injury, low back pain and gangrenous foot.

By the time I have time to rest it was almost 2:30am on Thursday morning.

Day Six: Thank God, we were able to snatch a draw from jaw of defeat

Today is our ward round and all we just have to do is to see our patients and report to our consultant. We have only two patients in our unit; one is in male orthopaedic ward while the other is in children surgical ward, both wards are almost a kilometre apart.

After reporting to my boss, I went to library where I was informed about a meeting involving all doctors excluding the consultants.

We are planning for our annual general meeting when we usually change the executives of our association. I am a member of the planning committee.

During the meeting we decided how much is to be deducted from salary of each member and how to go about getting sponsor for the programme.

My unit is still on call and it is turn of our registrar to do call while I am supposed to leave by 4:00pm.

Today is day 4 in European champions league and Manchester United is playing.

Thank God, we were able to snatch a draw from jaw of defeat.

I was able to lay my hand on heroes season 4 and that was last thing I did today.

Day Five: All our bed is usually always occupied

Today is our theatre day and surprisingly we have only two cases. Actually, we have three cases but I could not get a bed space for one of them. All our bed is usually always occupied.



Our first case is avascular necrosis of head of left femur of unknown cause. We did synovial and capsular biopsy to make a definitive diagnosis. Therefore, we used an anterior approach to collect our samples and sent them for histology, microscopy, culture and sensitivity and we requested zielnesten stain to rule out acid-fast bacilli.



Our second case is that 12-year schoolgirl who we planned for sequestrectomy on account of chronic osteomyelitis of left tibia. This really took a lot of our time because we have to do a good and thorough job.



My unit is on call this week so I have to stay behind to do post operative round and monitor other patients in the department. My house officer and I did post operate round around 6pm and I thank God both of our patient are stable.



I left for common room to await any consult from accident and emergency unit. And as at time I am typing this write-up, there is still no consult for me. Probably this is a form of compensation for all the work I have done today.

Day Four: He is not supposed to die

Today is Sunday. Apart from going to church on Sunday, the rest of the day is scary.



I have to go to hospital today to see my bad patient. I learnt he is being prepared for dialysis and any moment from now the procedure will start. I later received a call that my patient died on the dialysis table. I spent most of my time today thinking about this patient. He is not supposed to die.



I will put the blame on government that stubbornly refuses to renovate and maintain our road and poor quality of our health care system.



I tried to watch Birmingham vs. Manchester. City but I could put the death away from my mind so I decided to visit my female friend, the one I like most. She eventually made the matter worse by wasting my time when I got to her house. I have to leave in annoyance.



I seriously prayed in silence that she should come to my house to apologise but I guess God did not answer or I underestimate her stubbornness.



So have to sleep with one mind thinking about the demise of my patient and the other thinking my girl.

Day Three: Today is a bloody day in English premiership

I surprisingly woke up early today despite all my brag about sleeping with both my eyes closed. I even got to hospital an hour earlier than I use to resume on normal working day.

My patient has shown no improvement, the renal unit are thinking of dialysis, that will be tomorrow, and I pray that helps because seriously we are out of option.

Today was a bloody day in English premiership, I could count eight red cards been dished out. Sometime I question my claim of legendary love for soccer because whenever I see Chelsea, Arsenal or Liverpool winning I use to loose all interest. I am very happy man today because justice denied last week was properly meted out to Jamie Carragher this week and we won our match to go back to second.

I spent most of time today watching football and I use the remaining to check on my bad patient. Remember I am not the one on call, so I do not have to stay with him.

I decided to reduce my female friend to maximum of two because having many friends is time consuming and financially not advisable even if you are the stingiest of all men. I hope to go into relationship with one of them because I am tired of being single.

There was no power supply since morning. Therefore, I have to put on my power generator. Sometime it is expensive to live in Africa especially if you want to live like average American or Briton.

I slept early today after watching this week top ten on Trace.

Day two: My Beautiful House Officer

I got to work much earlier today though I am still about 5 minutes late.

In my unit we have a house officer, 2 medical officers, a registrar and a consultant. Though the other medical officer commences his annual leave tomorrow. House officers spend only 4 weeks in each department in surgery.

My present house officer is beautiful, nice and hard-working lady and I even thought of asking her to marry me but I was told in time, she is in serious relationship with a fellow medical officer.

Yesterday I told you about the bad case we have in our unit. Today was the decision time; do we continue on chloramphenicol or change to routine unit antibiotics. Personally I believe the fever was dropping because patient immune system could no more fight whatever is causing the fever.General surgeon advised us to stop all antibiotics while consultant microbiologist suggested we discontinued chloramphenicol.

My own argument is that you can’t use ceftriaxone and chloramphenicol together because one is bacteriostatic while the other is bactericidal. Eventually we stopped chloramphenicol, I have a feeling we were too late because the patient is now in acute renal failure from the latest renal function test.

Today is consultant ward round and I thank God it is Friday.

We commence patient on oxygen with plan to transfer to intensive care unit.

I spent my remaining time reading in the library.

I eventually got to my house around 7:30pm, I ate noodles and feeling very happy that today is Friday. For I will sleep with both my eyes closed.

Day One: A Very Bad Case in Our Unit

I woke up this morning around 7am Nigerian time. So I got to work around 30 minute late, though this is normal occurrence here but personally I try as much as possible to come to work early.

About 20 days ago we admitted a patient on account of multiple fractures involving tibia and fibula on both legs, left femur, right hip and right radio-ulna bones, following road traffic accident. We subsequently did multiple open reduction and internal fixation with fantastic post operative state.

However, around 8 days post operative day patient developed malignant like hyperthermia of unknown cause which has defied all form of treatment by combined team of microbiologist, general surgeon, physician and our unit.

Surprisingly today the fever came down with the use of chloramphenicol which we no longer use. Though I personally assume the man system has stopped fighting because aside temperature all other vital signs are poor. And this is a patient who we are about to discharge home.

Ordinary I officially close at work by 4pm if my unit is not on call but today I have to stay longer in the hospital to assist the nurses in monitoring this case; ‘don’t ever leave bad case for nurses to monitor for you’

Around 8pm I decided to go home finally. Remember I am not married, so I have no one to assist me at home. I think I should do something about this, oh God I need a wife, I mean good one. Of course I have female friends but they all are more interested in marrying me than loving me.

On getting home I saw 2 ladies waiting for me. Yes I know them but I am too tired to think clearly. Well one has to leave while the other fed me, got me a hot water to bath and off I am on my bed typing this diary.

I hope to type good story tomorrow…….. Snores

Day One: Introduction

My name is Olisa Olusegun. I am medical doctor working as a medical officer in department of orthopaedic, Federal medical centre, Owo, Ondo state in Nigeria.

Many of you might not know what ‘medical officer’ means: is a form of ’senior house officer’ but in my country it’s a position reserves for medical doctors that have not started their residency programme (a form of postgraduate programme), but have done their compulsory internship for a year and ‘national youth service’(if you are 30 year or below).

My monthly take home pay is below a thousand dollar in a month, though our tax system is not as greedy as you have in Europe and USA.

Statistically we were told there are 4 thousand Nigerians to a doctor but as far as I am concern, this does not reflect what is happening on ground. And very soon you will agree with me.

In my department we have 3 unit headed by a consultant orthopaedic surgeon. The head of my unit is also the HOD. So we are the ruling party. And as a result of this I don’t have to watch my back.

The Federal medical centre is a tertiary referral centre and serves more than 20 major towns and up to 100 villages

I am fan of football. At least that is what it is called in my country, and of course I mean ’soccer’. I support Manchester United football club.

I am more than 30 years and single. I live in 3 room apartment with a sitting room. In my country standard I belong to an average social economic status.

We will continue from here tomorrow.