Next patient

I've always hated weekend calls. Don’t get me wrong, I love my job. There’s just something about giving up twenty four long hours on a weekend to do the same thing you’ve done all week that riles me. That’s the thing about medical practice though, it’s supposed to be “humanitarian” meaning you’re expected to be selfless. That probably explains why at some point you invariably end up losing yourself. I worked at a state hospital in Lagos, which is undoubtedly the most stressful city in the world. Stress permeates every fiber of our civil existence, complicates every disease process, accompanies every patient on their hospital visit and eventually ends up being transferred to me. I can live with the challenges of inefficient administration, inadequate facilities and indigent patients; it’s the stress I can’t stand. I really don’t mean to gripe but it’s hard to let off steam where I work. One thing about working at a public hospital is that you never get to meet the guy you work for so it’s hard to know where to direct one’s complaints. Assuming I was one given to complaining which of course I’m not.
Some weekends are worse than others, one thing they all usually have in common though is an extremely busy out-patient department. People who are too busy working from Monday to Friday, suddenly remember to fall ill on Saturday morning. Traditionally, the out-patient clinic is closed on weekends, except for emergencies. However, when you work for the government, you are subjected to whimsical changes in policy dictated by political expediency. So the patients troop in to take advantage of the government’s, “almost free, anytime” healthcare policy, which sadly cannot afford to put more than one doctor on call on weekends. On one particularly dreary weekend, that doctor was me.
This was one Saturday morning I didn’t want to be at work. It had been a long week and I had suffered the indignity of a flat tire in the notorious Lagos traffic jam while returning from work the previous evening. First thing in the morning I was up again preparing for another twenty four hours plus at work, needless to say I was in a foul mood. As I drove to work I hoped that I didn’t get another flat, there’d been no time to fix the tire from the previous day and so I had no spare. Thankfully most decent people have better things to do than to go to work on weekends and so the traffic was very light. Half way into the trip though, the heavens opened up and the rain poured; the weather was in obvious solidarity with my mood. I drove at a crawl the rest of the way in a thunderstorm, visibility being almost zero. I arrived at the hospital fashionably late and made a quick dash in the rain from the car park to the entrance of the building. Stopping in the lobby to shake out my umbrella, I observed at least fifty or so patients just milling around waiting for me. “Looks like not even a storm can stop these people”, I thought dryly to myself. Most of them looked like they had nothing wrong with them worse than a hang nail. Some of the grown ups had brought their kids with them. Children can appear deceptively healthy. Now they’re running around raising a ruckus, the next moment their temperature may go through the roof. I usually avoid seeing children during the week as the hospital has a pediatric consultant, but on weekends I work alone.
As I made my way to the doctor’s call room some of the patients called out to me, they apparently wanted to know how much longer they had to wait. I ignored them; I didn’t mean to be rude I just didn’t have the energy to explain anything to anyone at that moment. My colleague from the call the night before was nowhere to be found so I went looking for him on the in-patient wards. Expectedly he wasn’t there either, in a flagrant breech of protocol he had left without formally handing over to me. He didn’t bother to make a phone call or leave me a note. “He got tired of waiting for you and left”, one of the nurses on the ward explained. I mumbled something about being delayed by the rain. The hospital (a health center really) was relatively small, three wards and about forty beds, all of which were often occupied. I conducted a leisurely ward round as I was in no hurry to get back to the out-patients. I believed the patients on the ward deserved the bulk of my attention and limited reserve of patience. At last I made my way back to those patients waiting for me in the clinic, “impatient patients” as I liked to call them. I guessed they had waited long enough. On a subconscious level, I probably hoped that some of them would just get tired of waiting and leave. Getting back there though that expectation evaporated, their numbers had swelled to over sixty and they all looked mad as hell. As I walked past them into the consulting room they stared daggers at me, some even swore under their breath. I just wanted to get the entire exercise over with; undoubtedly more patients would pour in over the course of the day.
Another thing about weekend calls, the nurses at the out-patient department do not work on weekends. This was obviously a legacy of the previous out-patient policy, besides there’s always the issue of a perennial shortage of nurses. There was no one to organize the patients, no one to take the blood pressure of the adults or check the temperature of the children. Most importantly, there was no one to direct them into the consulting room one at a time. I have often had to interrupt a consultation to break up a fight between patients arguing over who was to come in next. I had to direct the flow of patients myself. “First patient!” I yelled. They came in one after the other, many of them in apparent better shape than myself. Some of them were hypertensive and too busy to come in during the week for a routine check. “There are no nurses to check your BP today” I’d say almost gleefully, “you’ll have to come back on Monday.” Sometimes someone wanted to know, “why don’t you do it yourself doctor?” I’d grit my teeth and explain that the BP apparatus was locked away on weekends; there was no point in adding that routine BP measurement was not part of my job description. “Next patient!” On and on they came, droning on about their complaints. By the tenth patient I had stopped actively listening. After the first few sentences, I’d start writing a prescription. By the time they were done with their complaints their prescription was ready. I didn’t waste time with a physical examination, in most cases they usually yielded nothing.
I had concluded that every patient who showed up that day came purposely to waste my time when this woman walked in with a baby strapped to her back. Her appearance was very untidy and unkempt, the tattered robe she wore might have been the only clothing she owned. She looked haggard and unhealthy and the stale stench of her unwashed body made breathing the air suddenly uncomfortable for me. “This one I have to dispense with in record time before I suffocate”, I thought. She was obviously in need of medical attention herself but the only card she was carrying was for her child. “What seems to be the problem?” I asked in the vernacular. “It’s my baby doctor”, she replied. I let her list a litany of complaints before interrupting her sardonically, “so do I get to see the baby or what?” Glancing downwards mortified, she slowly undid her wrapper and let the child slide down from her back into her laps. I was startled by the her condition, she looked the very picture of death. Her pupils were rolled inwards exposing the white of her eyes, she was deathly pale and her lips had a bluish hue. She gasped intermittently and the slow rise and fall of her tiny chest as she struggled to breathe were the only significant movements she made. I put the back of my hand against her forehead, her skin was burning hot. “When did this start and how?” I asked the mother as I reached for my stethoscope. “It started with a cough about two days ago”, she replied. I fixed my gaze on her with an accusatory stare. “How could this have started just two days ago?” I asked raising my voice. “Look at the state of your baby. Had you brought her in earlier, perhaps we could have done more to help her.” I didn’t really mean most of what I said, it was a bit of reverse psychology I’d picked up as an intern working at a children’s emergency unit. Sometimes blaming the parents a little when a child was brought in very poor condition could prevent an assault on medical staff if the child eventually died.
I applied the stethoscope to the baby’s chest, it sounded like a boiler room in there. She obviously had a very bad chest infection. I tried to ask her mother a few more questions but the only reply she gave me was a blank stare. I grew exasperated; I started to think perhaps this woman didn’t care anymore for her child. She was obviously very poor and a dead baby might reduce her burden. “Your child needs to be admitted into intensive care immediately, we have no such facility here so I’ll have to refer you elsewhere” I informed her. There was no change in her expression, she maintained a stony silence. I wrote a quick referral note and handed it to her with instructions. “Take this quickly to the addressed hospital, do not use public transportation take a taxi. It’s urgent, go now or your baby could be dead before you get there”. She didn’t move, she just looked at me with that blank expression. A short while passed in silence, then I did something I’d never done before or since, something totally unprofessional and out of character. I reached for my wallet, took out some money and pressed the naira notes into her hand. “Go now hurry”, I admonished her. Slowly something inside her melted and poured out of her eyes coursing down her face in tears. She nodded her gratitude as she rose cradling the infant, “will my baby be alright?” she asked. “Yes, if you hurry”, I replied. She carefully strapped the moribund child to her back and mumbled, “thank you doctor” as she left the room with purpose in her steps. I looked out through the window as she walked outside the hospital gates disappearing from view. I noticed that it was no longer raining, the sun was out and all was right with the world again. It occurred to me that perhaps this was what it was all about, this medicine thing; helping people and not just treating them. What I had was not just a job, it was a calling. Perhaps it was time to lose the attitude. A timid knock on the door awoke me from my reverie. A young man peered nervously through the slightly open door. “Sorry doctor I’m the next patient, may I come in?” he asked. I felt ashamed. “Please do come in”, I replied trying to smile cheerfully. “How may I help you today?” As the young man settled into the chair visibly relaxing, I leaned forward and gave him my full attention. I had finally met the guy I worked for.