Tag Archives: sleep

The Most Precious Gift

It is 2 days before Christmas and everyone here is busy buying last minute gifts, wrapping them, decorating their personal spaces, starting Christmas lunch prep and all the other little things that make these holidays so great. I too am getting ready for a very special day and it is not Christmas. Sure I am looking forward to Christmas. I am going to spend the day with my husband in Oxford on Divinity Road no less with some of my dearest family. It will be wonderful I am sure but the day I am looking forward to comes later (hopefully much later!). I am expecting my first baby and my due date is 2nd of April 2016. Which means that as I am 6 months pregnant now, anything could happen. It could happen any day. Being a paediatrician, I am more aware than most of the unpredictability of pregnancy, going into labour and childbirth. I wake up every morning thanking God that my baby is still in there, safe and warm, their organs developing in the proper environment. I go to sleep praying that the baby remains in there for another couple of months at least.

Since I found out I was pregnant, I have been doing a lot of thinking and planning. As you do. First I have been thinking about time. Am I going to be ready for this? Many people have told me it will be the hardest, best, most satisfying, life-changing, painful and joyous thing to happen to me. I have always wanted to be a mother. I think even before I knew I wanted to be a doctor, I wanted a little girl of my own. I know I will love my child with everything I have and I know I have a lot of stamina (you can’t be a paediatrician and not have a lot of willpower and mental toughness). What I don’t know is will I be a great mother? Like my mother, will I be able to balance love and discipline, teach my child what is right and what is wrong and bring them up to be a decent human being? I pray for that the most. To be as good a mother to my child as mine was (and still is) to me. My mama is definitely a cut above the average mother. She was a single mum yet I never felt anything was lacking in my life. In fact when my sister and I reflect on not having a father, we both think that we have lost out on nothing and probably gained a lot from not having that side of the family to influence us. If our parents had stayed together, we would not have been nurtured in quite the same way. We would not have been encouraged to know and speak our minds in the same way. We would not have known that having a great mum is not just enough, it is the essential ingredient in a happy childhood.

I have tried hard not to think of all the potential complications that comes hand in hand with growing a baby and then delivering it. But I cannot escape the fact that this baby will one day be ready to come out and I will have to get it out (or at least give it my best shot). When I was studying obstetrics in medical school, a lot was said about the shape of pelvises and the birth canal. Particularly about which are favourable shapes (those with beautiful childbearing hips like my beautiful sister) and which ones are not – the android pelvis (damn you all!). I sat in the audience wishing that was a class I had skipped. So yes, I have an android pelvis (boyish in plain speak) so nature is not on my side when it comes to pushing this baby out. Thankfully, both my husband and I have small frames and the predicted size of my baby is small meaning I have a fighting chance. I will give it everything I can when the time comes to deliver the baby naturally. Fingers and toes crossed.

I have started setting up the nursery and not gone mad buying gadgets and fancy things all the moms tell me were never used. I look to my sister as inspiration. Before she became a mother the first time, she was a bit of a shopaholic. She would buy all sorts of useless things because they caught her eye in the spur of the moment. Then she fell pregnant and it seems overnight found self-control by the bucket-loads. She became super-organised and wrote list after list and budgeted. She stuck to her plans and her son had everything he needed but nothing was done to excess. Brilliant! I have made notes and I would like to be just like her. I have lists too and every time I tick something off, my little heart does a jig. I am on the way to being a mother.

Before I hit 24 weeks of pregnancy, I didn’t dare to dream about actually having the baby. That is because medically, I know that few babies born before 24 weeks of pregnancy survive and those who do survive, do so often with a lot of complications and a poor quality of life. I was terrified of having a baby who was more likely not to make it than make it. I did not want to think properly of baby names, of delivery, of breastfeeding, changing dirty nappies or being kept awake at night. Just in case this wasn’t meant to be. I know there are no guarantees in life and anything might happen yet but the longer my baby stays in closer to that due date, the more fighting chance we have of having a long happy healthy life together.

Lastly, I am ecstatic that I get to have a little person that I have (without putting much thought into it) been growing to love and cherish for the rest of my life. This baby is literally eating from my food, growing off the nutrients I have taken on board, sharing my blood, and getting oxygen from the oxygen I am breathing in. My baby is swimming around (I can feel the slow sliding rolling movements and the occasional sharper kicks as I write this) within my tommy, in a little sac of clear warm fluid. Maybe the baby is sucking their little fingers, blinking their eyes, practicing becoming a football player. It is the most amazing feeling to think that as I sit here this little person is being built in the incubator that was once the size of a satsuma which is now larger than a watermelon, shoving all my other abdominal organs out of the way to make more space for the baby. I cannot wait to meet my baby when they are ready to face the world. The one thing I do not worry about is that I will be at their side from the day they arrive until I am no more. I cannot wait for the beginning of the rest of my life.

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What does a Junior Doctor Do Exactly?

A letter written to Jeremy Hunt by a consultant currently working in England.
An excellent illustration of how indispensible ‘junior’ doctors are to the NHS and the public as a whole. I couldn’t have put it better myself so I haven’t tried to 😀

…………………………..

Dear Mr Hunt,

My name is Philip, and I am a consultant physician. Not so long ago, I was a junior doctor and like many others I am outraged and angry about what you propose to do with ‪#‎juniordoctors‬ and their ‪#‎juniorcontracts‬.

I thought that maybe, given you have not worked in healthcare, you might not understand what it is that doctors do (much like if I was made, say, head of Network Rail) so I thought maybe I can help you by shining a light on what I used to a few years ago as a medical registrar.

The medical registrar is the most senior medical doctor in the hospital out of hours. In explaining to my friends what we do, I tell them everyone who doesn’t need an operation right away, or doesn’t have a baby falling out of them, above the age of 16, is our business (and often we have to look after those too). We were the ubiquitous shirehorses that carried the hospitals medical workload day and night. And here’s a typical night shift I did at a general hospital. (all details changed and adapted from real cases to protect patient confidentiality).

I arrive at 8:50 PM for a 9:00 PM handover. It’s been a busy day and the emergency department is full. The outgoing medical registrar tells me there are no beds in the hospital. There are 10 patients waiting in A&E for the medical team, and a lot of patients need reviewing on the wards. He’s already admitted 36 patients during the day, and the consultant is still there seeing some of them with the daytime doctors. I wave hello at her as I head into the fray. I know the consultant and she’s not seen her kids since her on call week started. She waves back wearily.

My first patient for review was a young man with abdominal pain. My first thought as I walked into his cubicle, he looks sick. This is a skill you develop after years of training, when you look at someone and know that they are minutes from death. He’s grey, clammy and shocked. I immediately set about treating his shock and assessing why this has happened. Does he have a bad infection? Is he bleeding? Does he have a blood clot on his lungs? A quick bedside test confirms he’s bleeding badly, likely internally, and my surgical colleague (another junior doctor) and I urgently arrange for an operation. He hurriedly talks to his parents and completes a inacapacitated patient consent form as his condition deteriorates. I leave him in theatres with the anesthetists and surgeons as I have other patients to see.

The next patient was an elderly woman who has fallen. Although she has no hip fracture, she’s unable to walk and needs admission for painkillers and rehabilitation. I reassure her as best I can and stop many of her medicines potentially making her fall. There are no beds for her on the assessment unit or the elderly care ward, so the A&E sister arranges for a pressure support mattress and bed for her in the department overnight. She was lonely and depressed, and I spend some time talking to her about her worries and fears but after a while I needed to move on. She squeezes my hand and smiles, thanks me and settles for the night.

Next is a resus patient with an asthma attack. He is drunk and abusive verbally, though he’s too breathless to be too abusive. A blood test show his attack is life threatening and he he fights off attempts to treat him by myself and the A&E team, pulling off his nebuliser mask and oxygen. As I read out the blood test result to the intensive care registrar (another junior doctor) the man goes blue in the face, gasps and stops breathing. I drop the phone, run over and take over his breathing with a manual ventilator. He has had a respiratory arrest. Alarms blare, help comes running, we inject him with various medicines to help relax his airways and the intensive care doctor slips a tube into his windpipe to help him breathe. The consultant physician, still there, helps with what she could, running blood tests and helping to scribe in the notes. After a nervous period, he stabilises and we take him to intensive care.

It’s now midnight.

In the meantime I have reviewed five more patients, seen by the twilight team, and also my night SHO has discussed some patients with me. The consultant finally got home around 11PM. I’m now on the wards, a liver patient with severe cirrhosis is unrousable. I read through the notes. He has cirrhosis and is not suitable for a transplant. The team has tried everything. I sit and talk with his family, telling them I’m very sorry but there’s nothing more to be done. They cry, one of them screams at me that I’ve killed him, but I accept this as part of my job. With more assurance they’re calmer and I reassure them he’ll be kept comfortable.

My bleep goes off as I write in the notes. Is that the medical reg? The hospital is now totally full, can you please choose some patients to send to our sister hospital down the road? I groan, although I understand the necessity patients understandably hate it. I pick four stable patients and liaise with the registrar down the road.

2AM. I send my SHO off for a quick break as I review some more patients. A confused elderly man who might have a urine infection, a young man with severe headache, a diabetic patient with a very high blood sugar, a lady withdrawing from alcohol and hallucinating. The A&E sister makes me a coffee, lots of milk, lots of sugar.

3AM. I’m with a man in resus again, he is vomiting bright red blood in large volumes. He is jaundiced and looks unwell, very unwell. As the A&E team arranges for a massive transfusion to be set up, I ring the intensive care doctors and the gastroenterology consultant. He listens and says “I’ll be coming in”. I then slip a line into his neck under local anaesthetic, a practiced skill that’s hard at 3AM when you’re tired, but fortunately successful. We pour blood, clotting products, medications and antibiotics into him to halt the bleeding. The gastro consultant arrives at 3:40 and he’s taken to theatres where he performs a life saving procedure. The patient goes to ITU.

4AM. A brief moment to sit down for a quick break. I have reviewed three more of the SHO’s patients. This is the first time we’ve had a chance to sit down together, a quick chat and a cup of tea was interrupted by a cardiac arrest bleep. We run to the cardiac ward. A 54 year old gentleman admitted with chest pain by the day team has had a sudden cardiac arrest. The excellent CCU nurses are doing CPR and attaching a monitor. I ask them to stop as it’s attached, the rhythm is ventricular fibrillation.

“Back on the chest please, charge defib to 150, charging. OK, off the chest, stand clear, top middle bottom myself, oxygen away, SHOCKING.” The patient jolts. “Back on the chest please.” I heard myself say.

Two minutes later he has a pulse. We repeat an ECG, he’s had a full heart attack. I call the cardiologist at the heart attack centre 10 miles away. He’s accepted and an ambulance crew transfers him for an emergency angioplasty. I send my SHO back to A&E as I write a transfer note.

5AM. The resus doors burst open. Another patient, an elderly woman with breathlessness. The A&E F2 listens to the chest, pulmonary oedema. She’s given the emergency treatment but it’s not working. I decide to start her on positive pressure oxygen. Strapped to her face was a tight mask blowing oxygen to inflate her lungs, buying time for the medicines to work. The plan works and pints of dilute urine fills her catheter bag, her breathing improves and she says thank you through the mask. Despite the fatigue I smile and give the F2 a fist bump for a job well done.

7AM. Four more reviews. a patient with kidney failure due to medications, a depressed young man who took an overdose, an elderly nursing home resident with pneumonia, and an elderly man with a broken hip whom I assess with the orthopaedic surgeon. I start to round up the patients for the ward round. 18 patients overnight, five transfers out, one death. A relatively quiet night. I check with the clinical site manager and SHO that we’ve not missed anyone and click save on the list. No one is waiting to be seen, a good feeling.

8AM. The consultant from last night arrives, she looks tired but asks us how we’re doing. OK we said. We start in A&E as most of our patients are still there, the site manager is worried as some of the patients from last night are coming up to 12 hours in A&E. We review each patient’s story and tests, and talk to them about their condition. We visit ITU for the two new transfers there.

11AM. The ward round of the night patients are done, and I have completed a death certificate for a patient overnight. I climb into my car and listen to the breakfast show as I drive home, an hour away. I’ll be in bed by 1PM , and back for the night shift after 6 hours sleep. A relative luxury from a relatively quiet night.

This would be a relatively quiet night for a junior doctor and I am sure many registrars would laugh at how easy I’ve had it! But the people doing this work are junior doctors, who show dedication, commitment and goodwill beyond belief. They do lifesaving work up and down the country, working hard without complaining and sacrificing time with their families.

Please, I beseech you, treat them fairly and with the compassion they treat others daily. The new contract is not fair, and the extended hours it’ll cause is not safe. ‪#‎notfairnotsafe‬

I hope this little story will give you some insight into the vital work junior doctors and the NHS do. If you like, please come and spend a night at our hospital, I’ll come in with you and show you around. Please talk to my junior colleagues and listen to them, you may be surprised what you’ll learn.

Best wishes,

Dr Philip Lee

Do Your Little Bit of Good

Desmond Tutu says: “Do your little bit of good where you are; it’s those little bits of good put together that overwhelm the world.”

What a great saying! I fully subscribe to it. I think the world would be in a much better place if everyone believed in doing their little bit of good and did it thus creating a lot of goodness. Most of the people I meet are very good people and have really good intentions but only a few are doing anything to put their good will into action to help change the world in their little way. I suppose I am actually privileged to work in healthcare though. Nurses and doctors do so much fund-raising for charity that we almost take it for granted. Most of my work mates will have badges, hoodies, t-shirts all bought for charity. Many of them are taking part in charity runs to raise money for great causes.

Many of our amazing little patients are also into their fundraising. You may have heard about Stephen Sutton who died from cancer a few months ago. He has just been awarded a Pride of Britain award post-humously. His story has inspired so many because instead of focusing on his bad prognosis (predicted bad outcome), he thought he would raise money to help find a cure for cancer for those who have the misfortune of following in his footsteps and to support those young people and babies with cancer. Even if he had raised only a £100, it would have been amazing because of the intention behind it. The intent was to improve the lives of others when it was too late for him. The intent was to make the world better for a group of unlucky people who have or will have cancer. Great news is that he has raised £5 million pounds so far and counting and his name has been immortalised for being so brave and selfless in his time of despair and illness, for making a difference. Stephen probably never dreamt how big his fundraising page was going to be but he did what he did anyway.

Malala who has just won a Nobel Peace Prize at 17 years old and is a fellow West-Midlander is another inspiring story. Her story started out small. I am sure she never thought she would end up living in the UK making speeches that are heard all over the world and getting complimented by the likes of Barack Obama and the Queen. All she did was speak out against the injustice of being denied an education because she and her friends were unfortunate enough to be born girls in Pakistan. She got shot for her pains but instead of being cowed by the real threat of the Taliban, she remains unrepentant and continues to be the voice for her fellow oppressed girls and young women. She has inspired thousands of girls in Pakistan and Afghanistan to insist on their right to be educated. A small thing that has metamorphosed into a huge thing for so many.

My mama has an NGO that works primarily to empower women and young people. Part of what they do is provide support in setting up small businesses and training in crafts. They also help find and pay lawyers for victims of domestic violence and rape. But their manifest is unlimited really. Whatever a child, adolescent or woman needs that they can help with, they do. They have helped end many forced child-marriages; they have helped girls/women get away from abusive relatives and start up a new life. They help women who are desperate to support their children train in simple skills that will help them earn a living so they know where their next meal is coming from and know that they do not have to go from door to door, asking for hand outs. They provide extra tuition for young people struggling with their education and their prospects of employment. They provide sanitation and educate on public health issues. They have even helped a young lady locate her birth father. The work they do is not exactly earth-shattering to read about and does not make the news but I know how much good they have done for the hundreds of people who have come to them for help. I know what a lifeline they have been and continue to be for so many. They are doing the little good they can do with limited resources but it is changing the world for those around them in Yola and beyond to the rest of Adamawa state.

All of these people inspire me so much and as a result, I have made a promise to myself. I might not be anybody. I am certainly not rich nor am I famous. I am not extraordinary in anyway but I have been blessed with an amazing family, a few great friends, a fantastic job and a life mate (my husband) whose love is so uplifting. I guess you could say that I am extraordinarily blessed. So I try every day to do or say something that will do some good for someone. The best thing is that my patients are great recipients of my efforts. So many children just want positive reinforcement to shape them into lovely responsible adults. So I find something beautiful about them and tell them about it. I tell them how gorgeous their curly hair is. How special their rare blood group is. How amazing their natural red hair is. How beautiful their glasses are. How brave they are. How happy their hard work to get better makes me. How brilliant they are to do schoolwork when their health is failing. I say good morning to the cleaners that keep our hospitals clean and I smile every time I pass them in the corridors because their job is hard and their pay is small but they are absolutely essential in helping us make our patients better. I buy badges, hoodies and t-shirts for charity and I wear them with pride.

So I challenge you my dear reader. If you ever watch TV or read about someone who has done something and you feel inspired, do a little something each day to brighten up someone’s day. It doesn’t have to be big. It doesn’t have to cost you a lot of money; it doesn’t have to be recognised by anyone. As long as when you go to bed, you remember the feeling of having done something good for someone with no strings attached and fall asleep with a happy heart. Let us all do the little things that are easy and free in life and hopefully the sum total makes the world that much better.

On Death and Dying

My best friend confessed early in our friendship her fear of death and I remember being curious about why she was scared. Now looking back, maybe the question should have been why I did not feel the same? I mean of course death is not a welcome or happy thought but I don’t dwell on death and I certainly don’t actively fear it. I am very much of the school that there are 2 certainties in life: we are all born and we will all die. And since death is inevitable, I don’t think about it much.

Death is the final release.  Whatever one believes in, I think most of us believe that once you are dead, you don’t feel pain anymore. I know some people believe in reincarnation, some like me believe in the Hereafter and some think that whilst your body dies, your spirit never does and it still retains the memory of pain/anger/hurt/happiness. Although I believe in the Hereafter being Muslim, I do think that when I die, my soul leaves my physical shell and returns to its source (God). Then at some point, our lives are all assessed and we are rewarded (or not) for all our good deeds.

I wonder sometimes about what it feels like when your soul detaches from your body. I wonder if it is like a physical break, painful but transient or if it is more like an emotional separation where the after effects are long felt. I then wonder what the soul feels if it feels anything at all once it is separate from the vessel that conducts and interprets pain. Beyond that, I think death is more fearful if you are not the one dying. I mean, I would imagine that if I was in a terrible car accident, I would either die instantly with no time to think or become scared of what was happening. Or I would be in pain or feel myself getting weaker and weaker and it would be so unbearable that death would be a welcome reprieve. Same as if I had a chronic illness which was not curable but I was steadily deteriorating then dying would probably be a mercy for me.

When I think about dying properly, I realise that although I am not afraid of the dying itself, I am scared of some of the ways that I could potentially die. I am afraid after all. Being a medic, I have seen many people die so I have spent time thinking about the way I would not like to die. I guess one of the scary things about dying is that most of us do not have any idea when we are going to die. It is different for those who are diagnosed with ‘predictable’ illness but even there, giving patients a prognosis (i.e. a number of days/weeks/months/years they are expected to survive) is not an exact science.

In the past 6 months, I have come across patients who were not expected to survive being born and the first few days of life yet despite all odds, they are still with us many months later. I have also come across patients who were predicted more time only to deteriorate much quicker than anyone has experienced, giving no time for their loved ones to be prepared. The only people whose time of death can be predicted with any accuracy are those who are already brainstem dead but on life-support and when the machines are switched off, we can be fairly sure they will die within a certain time period. Even so, we have all heard of the ‘miracle’ stories where patients defy the odds and remain alive far beyond the expected time of death.

My ideal death would be the one most people wish for. I would like to die in my own bed, in my sleep. I would like for it to be when I am old but young enough that I am still completely independent. I would like for it to be after a family reunion where my nearest and dearest are all sitting around a table and reminiscing about the good old days. I would like for it to be after my mother has gone to her grave because I can’t think of anything worse for a mother than to bury her own child. I would like for my children (if I have them) to be old enough that losing their mother does not scar them too badly.

If I am unfortunate enough to have a catastrophic trauma and needed life support, I have told my closest family that I would prefer not to be kept alive for many days. I would like to be given a chance to recover (if there is one) but when it gets to the time where my chances of waking or recovering are much less that 50% then I would prefer for the machines to be switched off. I would like to be an organ donor although in my donor card, I have not ticked the skin donor thing because I am a bit squeamish when it comes to being buried with bits of my skin harvested. I don’t yet have a will but I have told my husband of my wishes verbally if I don’t get around to writing a will before the day comes.

I would like to be buried according to Islamic rites. I think the simplicity of an Islamic burial suits me perfectly. Washed and wrapped in a cotton shroud and buried within a day. If I am in my bed, the closest Muslim graveyard would be perfect but if I happen to be abroad in a strange land then I would like to be taken back to Kaduna, the town of my birth because that symmetry also appeals to me. Also my great grandmother and grandmother are both buried there so it would feel right to lie next to them.

When my grandmother died, there were a lot of tears and prayers and silence but there was remembrance every evening after the crowds dispersed and I found that uplifting. I think the sitting around the dining table and talking about Mammie’s life helped lift the gloom that surrounded us all. The fact that we could all remember and share our memories of Mammie reminded us all that although she was gone, a part of her was alive in us all. And that she had had a good life and her quick death was merciful. Those evenings also reminded us that life is transient. It is unpredictable and death can pick any of us at any time. In remembering our dead, we embraced life and were thankful for all we had been gifted with. I really hope those I leave behind can do that instead of it being all sad and tearful. May we all die a pain-free dignified death and may those we live behind be able to accept it is our time to go and may they have the strength to celebrate a life well-lived (hopefully).

Bonding with George

Last week, I was feeling out of sorts so I went up to the neonatal surgical ward to do some paperwork and get away from the Surgical Doctors’ room. As I sat at the desk staring into space and ignoring the paperwork, the student nurse walked by cradling a 2kg baby in her arms. I perked up immediately, baby = happiness to me. I asked her if I could have a cuddle and she happily passed him over because, she explained, he was a py who was not settling and needed to be held a lot. His name was George. Like my husband. Happy coincidence. I scooped him up and continued to do my paperwork. I got up to find a drug chart at a patient’s bedside and the poor little mite must have thought I was about to drop him when he grabbed my ID lanyard and held on for dear life. When I sat back down at the desk, I had to gently prise his hands off my lanyard and settled him back down.

I finished my paperwork and just sat there enjoying my cuddle when his nurse came to ask if I wanted to feed him too. She must have not expected a yes because she was very surprised when I jumped at the thought. After reassuring me that feeding a 2kg baby was the same as a chunky 4kg one (which I had experience of) and that he was likely to vomit afterwards, I put an apron on and settled in the armchair. Turns out George is a champion feeder. As soon as I popped the bottle in his mouth, off he went. I had to take the bottle out intermittently because I was worried he wasn’t pausing enough to breathe. As soon as the bottle was drained, he vomited up a third of the volume he had just guzzled down and then went back to sleep as I mopped him up. I tried burping him but he was already in dreamland so after about 5 minutes of a back rub, I went back to cuddling him until my bleep went off. George, bless him, was so comfortable the bleep did not jar him awake as I feared. I put him down for a sleep and dragged myself away to tend to my actual patients but you know what? My ‘out-of-sorts’ mood was cured. Glory be to George!