The first 24 hours.

The first twenty-four hours

The first 24hours was excruciating and grueling. I had stayed home for a whole year after medical school and I didn’t remember a thing about pregnancies, but here I was doing a 24 hour duty at the obstetric and gynecological emergency. During the day time, my MO was around so he managed all the cases that came, all were cases of vomiting in pregnancy which I could have handled but as soon as it was 8pm and the MO left a lady with severe abdominal pain coupled with bleeding per vaginum was rushed in. She had had a seizure on her way to the hospital as well, in the taxi.The history given by the husband suggested that she was 7 months pregnant, had never been to ANC before and hence had no records. He also mumbled something about her being ‘epileptic whenever she was pregnant’. She was also not registered on the NHIS.

Every detail of the history just dug my ‘confusion grave’ deeper. The woman had some serious conditions that could kill her unborn  baby and end her life in a matter of minutes and I didn’t have any clue as to what to do for her. ‘The essence of just learning to pass exams is to kill patients’. Prof Sawyer’s favorite saying reechoed in my ears. I was in deep shit. Maybe I shouldn’t have dodged all those lectures and bedside teachings. The day of reckoning had finally come and I was as guilty as sin.

I asked the husband to go to the hospital  records and make a folder for the lady but he retorted that he had no money and will not make any folder or any payments since he had heard everything is free at the hospital if you are pregnant. I had no time to argue so I ignored him and rushed the woman to the labor ward to do a quick assessment. The abdomen was very hard and every  slight  touch caused the woman to bawl. I vaguely remembered the term ‘woody hard’ which pointed to a placenta abruption. Hence I decided to manage her as such. The seizure came with its own diagnosis, eclampsia. The blood pressure of the woman was also in the skies.

I quickly secured an iv access and the midwives started the magnesium sulphate regimen. I put the woman on antihypertensives too. The final thing was to deliver the baby regardless of the gestational age. This one was 35weeks old. I prepared the woman for emergency Caesarean section.

 Everything was in place, the theatre people were poised and ready, blood for transfusion was ready in case we needed it .There was only one big problem, the husband. He had done  the  folder  after murmuring for a while but his issue now was that his pastor had told him never to allow his wife to do an ‘operation’ or else she would die. He had vowed to kill anyone who dared to take his wife to theatre and he was brandishing a machete in front of the ONG emergency. I had to think fast, the woman would die soon if nothing was done.

No  one had told me in medical school that I would be facing thugs with machetes at work, I would have have taken self defense classes alongside all the ‘-ologies’ I had to study, currently they were of no use to me. I decided to try and reason with the husband so I boldly stepped out of the labor ward to speak to him. As soon as I stepped out of the sliding doors of the labor ward the husband rushed towards me and swung down the machete with all his strength, he wasn’t going to give me the chance to even speak a word. I quickly opened one of the sliding doors and hid behind it. It  shielded me from the machete. The tempered glass of the sliding door shattered to pieces. My attacker’s weapon was now pointing down leaving him briefly defenseless so I jumped out of the doorway, got behind him quickly and bent his arm to his back, forcing him to drop the machete. However he was bigger and more muscular than me so he freed himself in no time. I barely had time to kick the machete far away from him before he jumped on me and started punching every part of my body that he could access. His muscles seemed to be made of steel. He probably visited the gym everyday, unlike me who spent all the 24hrs in a day  taking patients’ histories and  setting iv  lines.

He would have won the fight but his brains were probably not as steely as his muscles.The scuffle had sent me closer to the machete but my assailant had not noticed since he was busy punching the living daylights out of me. I gathered all my strength and pushed him away from me, using the brief freedom to pick up the machete. I  swung the blunt end of it hard on his  forearm  fracturing all the bones there with one blow. The injury had the effect I had in mind. He was right handed and couldn’t do much without his right hand. Also, the pain from two  fractured bones was going to keep him down for a while .

I was about to fracture his right tibia as well when someone tapped me on the shoulder . It was madam Helen, the nurse in charge. ‘Don’t kill him, the police are here’. I called them when the man started brandishing the machete but it took them some time to get here.’ ‘I don’t kill, I save.’ I responded. The MO had also been called and he asked me to go home while he took the patient to theatre to perform the Caesarean section himself. The police had come at the eleventh hour, ironically to save a man who had taken a whole labor ward hostage.

 I went back into the ward to tend to my broken bleeding nose and my bleeding lips. It had been only  24 hours since I started practicing as a doctor and already I had fought for my life while  doing my duty of saving lives. Practicing medicine was probably more dangerous than I thought. At this rate joining the army would have been a better option, at least you carried a gun for protection and defense. Stethoscopes were of no help when it came to saving your own life. Maybe  someone should add self defense lessons to the medical school curriculum.

E.Y.