Tag Archives: India

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

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My Very Own UN

My sister is (or should that be was) a social butterfly. She always had more than friends than she knew what to do with and she never had issues making new ones. A classic extrovert. I considered myself an introvert for most of my youth. Now with more self-awareness, I know I am more of an extrovert than an introvert but I am pickier than my sister, the true extrovert. Because I have been so picky, I think I have ended up with the best friends in the world.

Some of the people I am talking about might not realise how much I value their friendship or indeed that I am talking about them but I hope when I describe how fabulous they are, they will realise how great and valued their friendship is to me. When I was little and my mama was my only role model, one of the things I thought was absolutely amazing about her and her life was her array of friends. They were young and old, some local, many from far afield (and being in Yola that is quite something I tell you). Some Muslim, some Christians. Some skinny, some fat. Some beautiful, some not so beautiful. Some quiet, some loud. Many feminists like my mama. All sorts. The one unifying thing about them was that they were kind and caring, they spoke to me like I mattered and they were passionate. If she ever needed anything around the world, all she had to do was pick up the phone or send an email and the cavalry would arrive. Subconsciously, as I grew up, I think I looked for all those things in my would-be friends. I think I succeeded in developing my very own passionate, kind, caring, loving, helpful and loyal circle of friends. The inner circle is a small one compared to my mother’s but I happen to believe the best things come in small packages. I will talk about my current inner circle in no particular order as I value them all fairly equally. I won’t mention my mama and my sister but they are my best friends and are the core circle.

First one is my Ethiopian friend who I met in 2001 who I shall call Lizzie. We were in the same tutor group in Gladesmore Community School (10AH massive) and we both joined in year 10 so we had common group but our big unifier was where lived and that we had to get 2 buses to get to school. So, earlier than the other pupils, we were up and out, dragging sleepy bodies onto the 144 which I caught at the first stop in Muswell Hill and Lizzie would hop on 4 or 5 stops later in Hornsey. We were normally quiet in the 144 but by the time we got on the 41, we were awake enough to chat. It was on the 41 that I got to know Lizzie’s life story and about her very grown up relationships. At this stage, I had never had a proper boyfriend and despite having a crush at school, I wasn’t really interested in a relationship. So I lived vicariously through her. We also bonded over our love of heels (low enough to wear to school and get away from censure) and long braids. Also I have been mistaken for Ethiopian so we had a similar slim innocent look. We have remained friends over the years, closer after school than in school, through her babies and marriage, through my medical school. Lizzie was a bridesmaid at my wedding and she regularly makes the drive up to Birmingham from London to visit. Even though we had periods were we got too busy with our lives, she has remained a constant. We may drift (although not so much now) through complacency but we never fight and we are there to listen. So here is to my yummy mummy Landan friend. For being constant and loyal and inspiring me to be more glamorous and feminine.

Next is my Northern Nigerian friend who I shall call Halima. We met in 1996 in Queen’s College, Yaba Lagos and we were friends from the very beginning. It was the Hausa lessons that cemented the friendship and as we were both boarders, prep times and dinner times were there for us to foster the relationships. In another blog, I have mentioned Na’ima and I was close to a couple of other girls, 2 of whom were boarders. Halima was in a ‘House’ located all the way across the quadrangle which thinking about now wasn’t so far but during those years was enough to make visiting her during weekends a significant event. She was responsible for the one and only time I had periwinkles (the hairstyle) for Sports day in JSS2 (see blog on that). Those periwinkles make an appearance on my first ever British passport and my husband loves the photo so much he keeps it by his bedside. She was one of the only girls whose homes I would visit outside school too and I knew her family so that made her more special than many others. Post-QC, she is certainly the one who would always make an effort to come and see me whenever I went to Nigeria. I knew about her wedding as soon as she had a date in mind because she wanted me to be able to jiggle my doctor on-call to make it there.  I am so glad I did. We shared her pregnancy from across the distance too. In all these years, I do not remember ever fighting with Halima. She is probably one of the gentlest and sweetest women I know and her son and husband are so lucky she is theirs. Despite being many thousands of miles apart and despite our other friends from that era being on social media and living in close vicinity to her, Halima is the one of all that I would be able to count on today if I needed a friend in Abuja. What a sweetheart!

Then there is my Southern Nigerian friend, let’s call her Tolu. I met her through NLI which is a (NGO) Nigerian initiative to promote young accomplished Nigerians living at home and abroad to be the champions that make Nigeria great once again. NLI was in 2010, or was it 2009? I came from here and she came from the US. We bonded over our passionate pitches and speeches. Never before had I met a young woman who seemed so like me. She exuded integrity and honesty and passion. When I told my husband about her, the words I used were ‘Tolu motivates me to be a better person. I wish she lived nearby so I could be in her presence regularly’. Being next to her or chatting with her on the phone or on social media never fails to give me a positive boost. Tolu to me is everything a young Nigerian should be and she makes me so proud to be in the same circle as hers. If I could choose anyone for my baby to be like, it would be Tolu. She went through a very harrowing time a couple of years ago and being so positive and so strong, she didn’t say anything for a long time because she is that type of a person who will be everyone’s shoulder but have no shoulder to lean on herself. She has come through all of that in a way that is no less than heroic. She is generous and kind. She is a wonderful listener. She is passionate about life and justice and selfless in her outlook. Maybe I don’t want my baby girl to be like her, maybe I want to be like Tolu. Anyway, if you are reading this my love, I might not have said in so many words but your strength, honesty, passion and selflessness makes you wonder woman in my eyes and I could not be prouder of you. I hope your dreams for Nigeria and the world come through because this world is so much better for having you in it.

Following on neatly is my only fellow Iro-Nigerian, who I call Irish anyway. She is Irish in all the best ways possible except she lacks an accent being southern England-bred (sadly but she can put on a pretty good one). We went to medical school together and once again it was fate that brought us together because we met in student halls in 2004. Being the only two medics in the flat of 6, naturally we became close pretty quickly as we were together pretty much all day every day for the first 2 years of our medical school. We were up ridiculously early and gone all day. We couldn’t party any night of the week like a certain somebody we lived with. We had plenty of work and exams to keep us busy. The first thing about Irish is that she is a morning person. I am most definitely not. She would wake up at dawn even on weekends and whistle cheerfully. She had these dryer sheets that smelled of fresh laundry…even today, that lovely fresh scent equates to Irish to me. She has tremendous boobs (sorry Irish but I feel they need to be celebrated) and the loveliest bouncy hair which is NOT mousy brown as she used to claim. She is one of those friends I have never fallen out with. It’s strange to think but we don’t have fights at all. Perhaps it is because she doesn’t tend to get dragged into one of my deep philosophical conversations because she is quite squeamish with deep emotional stuff and would rather the happier topics. That is not to say that she won’t indulge me if I need to offload. She makes the best butter icing cupcakes and has managed to teach me to bake a couple of things. She loves sunflowers. That is in a nutshell Irish to me. She is little Ms Sunshine with a spine of steel underneath all the Gaelic charm. She will stand up for what she believes in and will call you out if you do something wrong but all with the sweetness of honey. She has dealt with family issues that would faze many but she remains unfazed and strong. She also has lovely blue eyes and dimples which I would give my little toes for. Oh and she gives the best hugs ever! If Tolu is the girl I want my daughter to grown up to be, Irish is the woman I want to be for my children. I want to be all sunshine and sweetness and quiet strength and I want to be charming just like her when I grow up.

Then there is my Indian friend who around birth was inadvertently called One on some documentation and that is my name for her which I shall stick to. She is the only one of my friends who is younger than I am. We met whilst I was out doing clinical experience in SEWA rural, Jhagadia – a village in Gujarat State, India. She was out there too doing field research and being the only other single girl resident in the flats on hospital grounds, we instantly gravitated to each other and became fast friends. She is a biomedical scientist. We quickly found common love in tea and laughter and feminism. We quickly fell into a routine. She would come over after ‘work’ to put her water in my fridge and we would go over to hers for tea. I would usually drape myself all over her bed and even occasionally on the cool floor for it was pregnant with heat during my 3 months there. My friendship with her is very similar to the one I have with Safa except the age difference and my having a bit more life experience. And our life stories seem to mirror each other down to meeting the ‘wrong’ boy as defined culturally but actually believing them to be our Mr Right. Unlike Safa though, she is the only one of my friends who is shorter than I am so I feel refreshing normal size next to her. One is rather fearless I think and having lived in remote Jhagadia for a whole year, she then applied for a post-graduate course in the US and off she went to live in NY. Now she is in Malawi, again independently sourced job and seems to be flourishing. What makes her so special goes beyond her fabulous tea, her wicked sense of humour and independent spirit. She is also very honest and open, kind and supportive, generous and when she loves, she gives it her all. One is going to be great someday soon. Mark my words!

Last but not least is my youngest adopted mama, Farah for today. I met her in 2009 as a lowly FY1 doctor in the crazy world of City Hospital (Birmingham). She was soon to be medical registrar and had a reputation for being brutally honest and fierce. Did that put me off? No! I love my women fierce and fearless so we became friends in the mess when I was on surgery and actually had time to go to the mess every day. I loved her unconventional ways and I think she liked me because though small and ‘quiet’ on the face of it, I gave as good as she gave and never seemed to take it personally when that sharp tongue was pointed my way. Despite the difference in years, in the hierarchical world of medicine, we remained friends over the years and have grown closer since we stopped working together. She is another one from a Muslim background who was born into the religion and though respects me for practicing, is not of the same opinions about it. I respect that despite being from a middle-eastern background, she is honest enough to say this is how ‘I’ feel about religion and all that comes with it. I love that despite that prickly first impression she gives out, she is a big old softie with a heart that is good as gold. She is loyal and supportive and she is always there for me if I need her. She wore a polka dot dress to my wedding – if for nothing else, I will love her forever. What a woman! Farah I salute you. You are one of my heroes.

There you are dear readers, my wonderful array of close companions without whom I would be less of the woman I am today. I will take this opportunity to say that for the reasons I have mentioned above and for many more that I cannot put into words, I feel privileged to have met and befriended you all. Thank you for all the love and support. I love you all.