Tag Archives: goodbye

The Cycle of Life Part 3

I could write and write about the many lives I knew that were cut short in their prime but I will complete the cycle with this last blog about one of my oldest friends. His name was Nabil. We probably met as babies but the first meeting I remember was when I was 15 years old. We had moved to London the summer before and were getting settled in still. My mama came home one day and announced we had been invited to have dinner the Ibrahim’s on Saturday. Who were they? I asked. She explained that they were old family friends. The parents were my grandparents’ friends and although their children were younger than my mother and siblings, they knew them well as children. I am told one of the kids had even stayed periodically with my grandparents in Lagos when they were going to school there. She told me that the oldest daughter had 2 sons, one my age and I was going to meet them.

Although we both lived in North London, it was quite a trek as there was no direct tube route and we had to go on 2 (or was it 3?) buses. By the time we got there, my nose, fingers and toes were frozen and all I wanted to do was curl up into a ball and sleep by a fire. I needn’t have worried. As soon as we stepped into their house, I felt my frozen cells begin to stir. It was always tropical in that house. Mum and Baba (the grandparents) like it very warm so there was never any danger of being cold once you got in there. I was introduced to the many adults, face after smiling face. It was like a mini-Northern Nigeria. All the warmth, the noise, everyone speaking Hausa. The boys were called down, Nabil and his little brother. They were instructed to take me upstairs until it was time for dinner. Although Nabil was friendly, he was definitely the quiet one. His little brother made up for it. He was very chatty, still pre-adolescent and full of excitement about life. Back then, he was quite small too. Very cute!

Nabil played us some music and told me about how they had only been in London for a year so were new to town too. He explained who was who in the family and we made general chitchat with his little brother telling us his fantastical half made up tales. We were in the same year of school and I was older by 2 months. By the time we got called down to dinner, we were friends. Over the delicious dinner cooked by Mum (his grandmother) and his mum, we talked some more. We exchanged numbers when I left. We stayed good friends over the years. We went to visit every so often and they made the trip across North London a few times too. We text occasionally in between visits. The next year, we talked about finishing year 11 and applying for colleges. I told him I was doing all the sciences and Maths because I would be applying to do Medicine. He said he wasn’t sure yet what he wanted to be so he was still thinking about which subjects to choose. We talked about where to go and I must have been convincing because I suggested for him to join me in Barnet College and he promised to consider it. He wrote down his address on a teddy bear notepad I had so I could sent him information when I had a confirmed place.

Common sense prevailed and he went to a college more local whilst I went to Barnet College. We went to see movies together and we even ate out at this stage, being all grown up at the ripe old age of 17 and 18 years. Every time we went out, he would insist on paying for everything and I would argue him down so we went halves. His little brother had grown into pre-adolescence by then and would irritate Nabil endlessly. His patience was great and he would repeatedly ask him to butt out of our conversations. I didn’t mind. I had a sister too and as the younger sister, I knew what it was like to be the little one. When we applied through UCAS for universities, he finally had a plan. He was going to study Maths. I was shocked. I mean, I was a straight A student and I got my A in Mathematics, an A* even in AS. I was no slouch when it came to it but to do a whole degree in Maths? I was agog! Why would anyone in their right minds do such a thing? He took my teasing in his stride. He said he didn’t have a profession in mind like I did and he knew he could use his generic Maths degree to do a wide range of things. I accepted this but I still thought him mad. He gave me that calm smile of his. ‘You’ll see’, he said.

As is the norm, we saw each other less when we went off to different universities. I went to Birmingham and he stayed in London. We probably saw each other once a year but when we did, it was like no time had passed at all. Ours was a very easy friendship. He would tell me about his ‘crazy’ Maths course. He seemed happy. I would tell him about Medicine and how much of it there was. How I realised more and more that what I knew was only a small fraction of how much I needed to know. He was openly impressed by how well I coped with it. His support and belief in my abilities were unwavering. Just like his friendship. I knew he was there somewhere should I ever need a friend. We text and Facebooked more than we spoke face to face. I can count the number of times we spoke on the phone in all the years.

Over the years, I would tease him gently about his girlfriend, or lack of. As the Fulani girl, I should have been more embarrassed to talk about such things but he was so shy about it. It became part of our friendships. I would needle him about ‘her’ and he would counter by asking me about my many boyfriends. I wasn’t shy about it. I had very little in the way of boyfriends but I told him of every encounter and how I preferred not having a boyfriend. He never admitted to any love interests but his brother was a more open book and I know there was somebody special at some point. He graduated and started an online sales platform. Next thing, he was talking about going back to Nigeria for his NYSC (mandatory youth service). He settled in Lagos. I happened to go the Lagos route once in his time there so I got to see him. He looked way too skinny and I was worried. As a newly-qualified doctor, I saw ill-health everywhere and was concerned he wasn’t sharing. He reassured me that he was fine. I didn’t need to doctor him. I believed him because youth corpers do tend to look the worse for wear during their year’s tenure.

The last time I saw Nabil was in Life Camp, Abuja in 2011. He happened to be visiting Abuja whilst I was there on a 10-day holiday. He was staying with a friend who brought him over. Again, I thought he was too skinny and he laughed it off. ‘Maybe I was always meant to be skinny like you’, he said. We chatted for an hour and he had to go. As we hugged goodbye, I felt how bony he had become. Life in Lagos was a hard one for a young man trying to start a business. My parting words were ‘You need to eat more. You should look after yourself better.’ His reply was a laugh and a ‘Yes doc!’ I stood at the door and waved until the car was out of sight. Not for a second did I imagine I was saying goodbye for the last time. The fuel subsidy crisis in Nigeria was the last thing we ever chatted online about. He became very involved in the demonstrations. I worried about his safety and he sent photos of himself and his friends at Lagos marches, looking happy and less skinny. He had found a cause to believe in. I was proud he was making a stand for a cause.

News that he was ill came out of the blue. I was in Yola, having taken a year out from working in the NHS to see the world. My mama got a call from one of his relatives saying that he was in hospital with a bleeding illness, cause still unknown. It was pretty serious and they were considering transferring him abroad as the healthcare available in Lagos was deemed inadequate. When my mother related the facts, I wanted to know more. What sort of bleeding? Was it related to a fever? Was Lassa fever the suspected cause? When my spoke to them again later, she was given more details. He had woken up that morning and told the friend he was living with that he wasn’t feeling too well. I think there was mention of a headache. He had been well the night before going to bed. His friend had gone with him to hospital and he either vomited or peed blood. The exact sequence is hazy but the gist of the story was that he had become sick rather quickly and what started out as an isolated bleed was now bleeding from multiple sources. He had been given a transfusion, we were told. He was conscious but seemed to be deteriorating.

When my mama related all of that news, I immediately thought the worst. When I burst into tears, she was alarmed. ‘He is alive,’ she said to me. ‘Don’t write him off.’ I tried to explain what I was thinking. I didn’t want to be a pessimist but unexplained severe generalised bleeding had a poor prognosis even with the best medical care. And he was not getting that. Not yet anyway. I had 2 professional experiences to draw on, both rather negative. My first experience of a patient with uncontrollable bleeding was in Malaysia on my medical elective in the 4th year of medical school. He was brought in by his heavily pregnant wife and a male relative to the A&E where I was working. He was very quickly diagnosed with Dengue Haemorrhagic fever. However, before any real treatment could be commenced, he went into cardiac arrest. With the medical students and his wife watching, the doctors performed CPR. It was horrific. He began to bleed from every orifice imaginable. His ears, nostrils, mouth. The blood was coming up the tube he had inserted into his lungs to ventilate him. The only part visible with no blood streaming out of it were his closed eyes. It was over as quickly as it began. It was obvious to everyone that he was far too ill to be saved. His wife was led away with the news.

The second experience was indirect. I was working in FMC Yola (Federal Medical Centre) and although Yola was ‘free’ from Lassa fever at the time, there were new cases being reported further south of the country. In fact, about 6 months before I had started working at FMC, there had been a patient with Lassa fever there and 2 of the doctors had contracted it from him. Unfortunately, 1 had died and the second had got to the Lassa Centre down south in time to be treated. He was one of the registrars on the paediatric team I was working with. So although he was okay, it seemed that mortality was quite high and only those who were diagnosed early and treated before they started actively started to haemorrhage (to bleed) were salvageable. Nabil’s story didn’t quite fit the bill because he had not complained of a fever and indeed had no fever in hospital. But it was my best guess with the facts I had and I feared the worst.

I pulled myself together eventually and prayed and waited with my mama. Next time we got an update, it was to say he was worse still, I suspect barely conscious at this stage. He was still bleeding despite all efforts and his parents were with him (they don’t live in Lagos). An air ambulance had been organised and he would be transferred abroad as soon as possible. We even heard he was being placed in the ambulance and I thought maybe there is some hope after all. That hope was short-lived. We got a call a few hours later to say that although his parents were in a flight to London, his air ambulance had never taken off. There were complications and unfortunately, he had not made it. I was so upset! All I could think is how his parents had no idea he had died and how they would have to make the return trip with that news weighing on them. To be honest, I have not asked them what happened exactly but it could only have been a terrible day.

I think the initial reaction of tears had taken the edge of my grief. I had started my grieving process before he was gone. I sat around in disbelief as my mama asked if I would be okay. As we made arrangements to go and visit his family, I could not stop thinking about how final death was. That was it for him, in this life anyway. I have no brothers so I whilst growing up, I found a handful of boys/young men to be my shining examples of decency in the male sex, my torch bearers when I felt dark about men in general. Nabil was one of them. Here was a gentle, calm, positive young man who believed in doing what was right, what was decent. He was respectful of God, his parents and our culture. He was a great friend and it was clear from the few times that I spent with him in the company of his family and friends that he was an all-round good guy. Losing Nabil was losing a little of the light in the darkness that sometimes surround men for me. Nabil was a good guy. Now he is no more. It took just over 2 days for a healthy young man in his mid-20s to sicken and die. Muslims would say it was time to go. I accept that but did it have to be such a horrible death? What did he ever do to deserve such an end? Why him?

The Expiry Date

This morning I read drkategranger’s blog regarding her expiry date (she is a doctor with terminal cancer who talks about death so candidly, it inspires. I would absolutely recommend!!!). The blog and some of the responses to it got me to thinking about death. I have already written about dying and the fact that I fear it not so much. As a Muslim, I tend to see death as just one of those certainties of life so I treat it quite matter-of-factly. This blog is will be further musings about my experiences of death. I will start with a quote from Hadith (Islamic teachings) which summarises how I generally see life and death:

Al-Hasan Al-Basrî said:
‘The life of this world is made up of three days: yesterday has gone with all that was done; tomorrow, you may never reach; but today is for you so do what you should do today.’ Al-Bayhaqî, Al-Zuhd Al-Kabîr p197

I am generally an optimist or more accurately an optimistic realist so I try not to be morbid and I am generally not one to dwell on death. However, I have had times in my life where the thought of dying has crossed my mind. Last winter was a pretty bad time for me. I was working in the hospital that inspired me to become a paediatrician (which still inspires me) but I was in a job with a particularly toxic individual who succeeded in poisoning the atmosphere. I became depressed after 6 weeks of this. So much so that I hated waking up every morning I was scheduled to work. It got to a point that I would lie in bed, sleepless and think ‘would it be that bad if I didn’t wake up in the morning?’ As soon as the thought came to my mind, I would feel guilty and terrible. Guilty because I knew that my life really wasn’t that bad and that there was so much for me to be grateful for. Terrible because I knew my death, although insignificant in the grand scheme of things, would be horrible for my nearest and dearest. My mama especially. I got through those 4 months because my husband was there and would not let me sink into the depths of depression that kept pulling at me. Thank you George!

I am now back to my normal sunny self despite some current work horrors. As a newly-qualified doctor back in 2009, I dealt with death day in, day out especially on my first job on gastroenterology at a busy inner-city hospital. After the initial shock, I got used to it. Not that I didn’t care or it didn’t bother me but I dealt ok with it. There are 2 patient deaths from those days that have stayed with me. Both died of alcoholic liver disease. Both men in their 40s.

The first patient died slowly from hepatorenal syndrome (HRS). Basically with chronic liver failure, if your kidneys too fail, you will die soon because that means 2 of your 4 vital organs are dead or dying, unless you get brand new organs (i.e. transplants). As things currently stand, you cannot be put on the transplant list for a new liver if you are still abusing alcohol because the new liver will get damaged just the same and it is considered a waste of an organ that is in high demand but short in supply. So with my first patient, who I will call Patient A, when his kidney function tests declined rapidly and nothing we could do medically fixed it, we diagnosed HRS and my registrars and consultants had a meeting with his wife to inform her of the diagnosis and what that meant for the patient. He too was told in due time but because of his liver failure, he was confused and did not fully grasp the fact that his condition was terminal.

He deteriorated slowly over a few weeks but in the meantime, he would ask me daily when he could go home and travel to India to be blessed in the Ganges River. I would mutter something non-committal and beat a hasty retreat out of his side room. Initially, it was clear that his wife knew his death was near. But even she began to belief he would miraculously recover from his liver and kidney failure. Every week, she would say something that made us worry we hadn’t prepared her for the inevitable. Every week we would remind her gently that although she couldn’t see it, he was in actual fact deteriorating judging from his biochemistry lab results and worsening oliguria (he was weeing less and less).

In the week of his death, he suddenly looked well again. If I wasn’t the doctor patiently doing bloods on alternate days and chasing those results and noting the relentless rise in his urea and creatinine, I too would have started to believe in miracles. His wife upon seeing the light return to his eyes and his demeanour brighten plunged headlong into denial and joined him in planning their trip to India to the Holy Ganges River. Less than 24 hours before his eventual expiry date, it was devastating for me to watch her grief as the light in his eyes faded rapidly and he shrunk back into himself. Within 12 hours of his final illness beginning, his strength was gone and his mind with it. His utterings became incomprehensible and he became completely disorientated. The look on her face said it all when we came in to see him on our ward round that morning. We returned the look and she ran out of the room to sob in the corner. He was anuric by then (had stopped weeing completely) with a creatinine of over 400 (in other words, his kidneys had packed up). His liver function tests painted an equally damning picture. We completed his end of life paperwork that morning and when we left work that evening, he was hanging on by the tips of his fingers. We came in the next morning to the news that he had died before the end of the day before. The side room he had occupied for many weeks stood empty, awaiting its deep clean before the next customer.

Patient B was a young alcoholic who had developed liver cirrhosis in the months before I started the job. He had just turned 40 and I don’t think had any idea how serious the consequences of regular alcohol binges could be. Reality hit when another patient who was his ‘neighbour’ on our ward developed HRS and died rather quickly. All of our words of warning had somehow not sunk but with this other patient’s death, his mortality was clear to him. He called me over urgently that afternoon and said ‘Doc, I am ready to change’. I was pleased and felt a sense of accomplishment when I referred him to the rehabilitation programme. His wife found me the next day before they were discharged home to thank me for getting through to him. I was honest to say it wasn’t anything I did.

Unfortunately, he came in a few weeks later unwell with an infection which caused his liver function to deteriorate badly. I was encouraged to hear that he had no touched a drop of alcohol since his last admission. He developed litres of fluid in his tummy and I had to put in a tube into the side of his tummy to drain out all that fluid. He was in a lot of discomfort and fearful for his life and he asked me ‘Doc, am I going to die?’ I hesitated over the words I used but in the end I made no promises. Just that I would do everything I could to help him get through this. At first, it looked like the drain and intravenous antibiotics were effectively doing the job and the next day, the fear was gone from his eyes. I was encouraged by his blood results and left having ordered some more routine bloods for the next morning. Coincidentally, at I was securing his abdominal drain, I carelessly dropped the needle I was using to suture and when I went to retrieve it, gave myself a needle-stick injury. I had to get a co-doctor to inform him and take blood samples off him to check that he didn’t have any blood borne infections I could catch. He apologised every day after the event like it was his fault I had stuck myself with a contaminated needle. He asked me about those results daily – he seemed genuinely to care for my welfare. This went on for over 2 weeks as he slowly improved.

I was doing the ward round alone one morning when I was called urgently to his side. He was in a great deal of pain and was writhing in his bed with his abdomen larger than before we drained him. He was pale and clammy and his eyes looked like a man staring down the barrel of a gun. I could barely make sense of his words and as I changed his prescriptions, called the blood bank for blood products and prepared to get a new drain inserted. I could see the life begin to ebb out of his eyes. In a panic, I called my registrars and told them I needed them on the ward ASAP because patient B had taken a turn for worse and nothing I was doing was making a difference. The registrar told me to leave the drain for the meantime and focus on reassuring the patient. After I asked the nurses to call his wife in, I went to him and I held his cold hand. I looked into those eyes and I knew in that instant that he was not long for this world. I remember saying a mental prayer that he could hang on for his wife to be by his side.

‘Doc!’ he cried. I squeezed his hand and responded ‘Yes B?’

‘I am dying aren’t I?’ he asked. I looked down and swallowed the lump in my throat. ‘I am here for you B and I will do everything I can to help you. Your Mrs is on her way in.’

‘Stay with me,’ he entreated fearfully. I nodded and again I had to look away because the fear in his eyes was too powerful for me to take in. The rest of it was a blur. His wife made it in before he died but not in time for him to know she was there. He was delirious by the time she got to the ward and as he was slipping away before our very eyes, there was little time to have ‘that conversation’ with his wife. The consultant whisked her away and broke the news to her. She could see that treatment was futile by then and knew that he was on maximal available medical treatment. We had no more to offer. She signed the DNAR (do not attempt resuscitation) forms and we set about making him less agitated. When we finally called it a day, he was less distressed, still mumbling incoherently and his eyes had started to take on that distant look I now associate with death. I came in the next morning to a request to come to the morgue to complete his death certificate and Crem forms so that his wife could lay him to rest. I got a call 3 days after his death to say his blood tests for blood borne infections had come back negative so I was in the clear. I cried in the staff toilets. He would have been relieved not to have put me at risk I think.

What did patients A and B teach me about death and dying? Firstly that when it is your time to go, it is your time to go. Life unfortunately doesn’t usually give you a clearly labelled package with an expiry date on it. Secondly, although death is scary for the person dying, it is actually worse for the person who loves them who has to watch them lose their battle to live and battle their fear of the unknown. Who has to go home and face life without them and rebuild their lives around the hole left by the dead loved one. Who for a very long time will think about their dear departed every morning when they wake up and every night before they fall asleep. Lastly, every human is unique. Despite having the same disease and modifying your risk factors, your body will do its own thing. We doctors can try to influence outcome but whether we succeed or not is not within our power to control. That is beyond science and medicine. That is life. That is God. That is reality. May we all depart this world in the easiest swiftest way possible. Amen

A Baby Boy

Dedicated to Fareeda Rasheed – an aunty-in-law and a dear friend taken too soon! 

I am one of 2 girls and for most of my childhood my mama was a single mom so my house was a boy-free zone mostly. No one peed standing up so we didn’t have the toilet-seat-left-up issue or the bits of wee that missed their mark and ended up outside the toilet ball with the associated whiff. No one with boy bits so walking around naked was never awkward outside of ‘visiting hours’. Nor was accidentally opening the toilet door when someone was on the toilet. We were all the same so it was a quick sorry and everyone forgot about it minutes later. As a result, whenever I pictured being older, getting married and having babies, my babies were girls. And to tease me, my sister would say you will have only boys and I would react either with a strident ‘God forbid’ or ‘I hope not’ or ‘please God don’t do that to me’ or similar save me somebody phrases.

 My uncle’s first baby was a boy, who we nicknamed Baby A. His mother was lovely so we became fast friends after the wedding. I was 12 years old. She turned up unexpectedly for one visiting day at my boarding school when I was in JSS1 (first year of secondary school) with a baby bump and I got so excited! This was going to be my first cousin within reach (I have 2 cousins in faraway America). I prayed hard that it would be a girl so I could dress her up and play with her hair. We spent the summer with my aunty and the baby was due the week before we went back to boarding school. We hoped and hoped it would arrive before we had to leave but as these things tend to happen, there was not a peep from the baby. We said our disappointment goodbyes, patted the bump one last time and left.

 2 weeks later, he arrived with great fanfare but I wasn’t to meet him until the end of term. He was 10 weeks old when I first met him and at that stage, he was cute but didn’t do very much. He just fed and slept and I couldn’t even dress him up in cute pink dresses and hair bands. I was pleased but not bowled over. This all changed 5 months later. It was the summer holidays and his mom had decided to relocate to my hometown Yola to learn Fulfulde (the Fulani language), do a HND in Law and generally learn the ways of her husband’s people.

 On weekdays, my sister and I were on babysitting duty from the morning until she came home from Legal studies as the college was called. Being adolescents on holiday, we stayed up late every night and then had a lie in each morning. There was nothing much to do apart from visiting friends and going to buy sweets or drinks from the one main road where all the shops were situated. Sadly, we were by then too old for playing sand games or climbing trees. We were young ladies. Haha.

So back to Baby A, his mom would wake up bright and early, feed him and bring him round to our house. Then, rather than wake us up (which was an impossible task) she would place him on the blanket between my sister and I and sneak out. My sister was the better sleeper so I was generally the one to wake up. The first thing I would notice as I stirred was that the blanket wasn’t moving with me. Then I would feel like I was being watched. Eventually, I would be awake enough to crack open one eye and scope out the situation. Each morning, Baby A would sit patiently and wait for the eye to pop open. Then his face would break into the most disarming irresistable grin. My heart would melt and instead of the usual grumpy awakening, I would pop up and give him a cuddle, drawing from him happy chortling. My sister was soon up in the face of all the merriment. We spent nearly 3 months in this idyllic way.

 We would compete over who would feed him, who would carry him, who would burp him and even who would change his diapers. He was the sunniest baby. Hardly ever cried. Always smiling or laughing. We were there when he mastered how to sit without support and there as he started to crawl and then pull up to stand. By the end of the summer, he was standing and even attempting to take a step. It was with a heavy heart we said our goodbyes when it was time to back to boarding school. This was the beginning of my boy baby love.

 We relocated to London so I missed the infancy of the next boy cousin to be born. Then, when I was in medical school, the news came that my other aunty (wife to uncle no 2) was expecting a baby and he was due during Easter holidays. His grandmother is Egyptian so his mom went to Cairo in preparation for his arrival. My grandmother (her mother-n-law) was also going to be there so I saved up money for flights and I flew to Cairo. He was due the first week of my 4 week holiday. Her tummy was so huge it looked like it would burst and everyone predicted that he would be early being the second baby. Despite her busy upping and downing with the hope of inducing natural labour, she ended up having a caesarean section as there were safety concerns.

 I was much more excited to meet this little boy and he was gorgeous. All black curly hair and very Fulani features. I spent 2 weeks with Modi (that’s his Fulani name) then had to come back. I didn’t see him again until he was 11 months old and I had a 3 month summer holiday. I spent most of it in Kaduna in their home getting to know him. I was his constant companion. Imagine my joy when his first proper word (after da-da and ma-ma and ba-ba) was Diya! I was chuffed. We all went to Abuja together when it was time for me to head back to Birmingham. I was off the next evening. In Abuja, I stayed at my grandparents whilst they stayed at their Abuja home. I went over the morning of departure and spent a few hours saying goodbye to my little sidekick.

 As I got into the car to go back to my grandfather’s and get ready for my flight, he came running out as fast as his little legs could carry him. He bent forward with chubby hands on his thighs and screamed my name as loud as he could. I heard him through the closed windows and slid the window open. His tears broke my heart and I felt myself welling up. I was going to stay a little longer but his mom said ‘no go! I will get changed and bring him over before you go so you can say a final goodbye’. She lifted him to the window and I gave him a quick kiss then detangled him and we drove off. She never did bring him. Looking back, I am glad because I would have made him cry a second time and made it even harder to say goodbye. It was 2 years before I saw him again.

Baby A and Modi were the best convincer for me to be happy with whichever sex baby I may have in the future. Now I look to the near future as a married woman wanting children and all that I pray for is a healthy boy or girl.