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.