​RAMADAN LIFE OF A MUSLIM DOCTOR

 

Switching from pre-Ramadan to Ramadan mode can be very challenging for those of us in the “special duties squad”… Health care professionals, security personnel, etc. It’s much better when you’re working in a place where there are other muslims to identify with. Otherwise, you have to contend with people eating, drinking and gossiping around you while you’re fasting. 
The painful part is having to (occasionally) eat suhoor and iftar in the hospital, away from your family. Sometimes, it becomes inevitable to skip suhoor when you’re in the middle of an emergency which doesn’t get resolved until fajr. Sometimes you miss the taraweeh in jama’ah and have to make do with witr plus/minus 2 or 4 raka’at whenever you’re free. You plan to finish 2 rounds of tilaawah, but you end up struggling with one… All the same, AlhamduliLlaah! 
When work gets busy, time runs fast.  Before you say Jack Robinson, it’s time for iftar. The excitement of serving humanity and saving lives makes you forget about hunger and thirst. The sight of patients in pain and suffering makes you see the home-cooked iftar as a non-issue. The constant reminder that sickness and death doesn’t respect age or status, makes you more humble and thankful. 
Personally, Ramadan makes me more patient with patients. I’m more calm when talking to them. I can listen more attentively. I’m able to show more empathy. I don’t mind if you’re malingering, I’ll hear you out and offer you soothing counselling after your rant. I feel how it is to be hungry, so I understand how a patient on “nil by mouth” feels… 
Ramadan is such a blessing and a period full of lessons. If Ramadan doesn’t make you more pious, I wonder what will. 

O Allaah, open our hearts to receive the blessings and open our eyes to see the lessons. Aameen. 
“O you who believe! Observing As-Saum (the fasting) is prescribed for you as it was prescribed for those before you, that you may become Al-Muttaqun (the pious) – Qur’an chapter 2 verse 183. 

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DOCTOR! YOU TOO? 

By now, we should know that doctors aren’t free from illnesses. No, I’m not referring to malaria and chickenpox alone; I’m talking about serious, life-threatening physical and mental illnesses. Yes! like depression. That’s exactly where I’m going. Doctors aren’t free from depression; they are, in fact, highly susceptible to the disease. 

Most unfortunately, an average doctor will deny or ignore symptoms for a prolonged period of time. He will not seek help even when he knows that he should. He would come up with excuses and reasons to hang on – 
“I have dying patients to attend to. I have exams to pass. I have a huge paperwork to complete. I have a narcissistic boss to impress. I have aged parents to care for. I have a spouse who doesn’t have me. I have children who only see me for a few hours in a week (while I’m already burnt out). I have extracurricular dreams and aspirations to fulfil. I have my faith to protect. Yet, litigation and severe penalties await me if I err… “.

He has all these worries on his shoulders but he’s expected to meet the world with a big smile. He still has to play demigod and save lives. Now, add all the “Nigerian factors” to the above and tell me why he shouldn’t have mood swings, if not full-blown depression. The health sector is rotten and the workers are the ones inside the bottomless pit of this rot… 

And no, I’m not justifying any error committed by a doctor. I just want you to know that a doctor CAN be depressed but smiling. Go out there and show a doctor some love! Neither am I discouraging my brothers and sisters from studying medicine. You are welcome. We need you. But know, that medicine is not for the fainthearted. You have to be strong. The thought of quitting will mess with your head from time to time. If you must quit anything, then quit medicine, not your life.

OF DOCTORS AND ILLEGIBLE HANDWRITING… 


As early as the age of 5, everyone in my family, neighbourhood and school knew that I wanted to become a doctor. While I maintained excellent marks in most subjects at school, one subject remained very poor – handwriting. However, people weren’t bothered because they believed in the myth that doctors don’t write legibly. The only person who didn’t accept this theory was one of my elder sisters.

Aunty Laitan is an architect par excellence with that typical calligraphic handwriting. When I was about to begin JSS1, she asked me to go and get a “2d” exercise book and she started teaching me how to write legibly. May Allaah reward her. My handwriting has gone through different changes over the years and it may not be one of the best out there, but I can say it’s good enough.

Having a bad handwriting is not part of our profession. We’re never taught to intentionally write illegibly. In fact, medical students have failed exams because of poor handwriting. Doctors have been sued for same. Pharmacists and medical record officers don’t tolerate illegible prescriptions and documentations respectively.

Many people think that doctors don’t write prescriptions legibly because they don’t want to disclose the name of the drug(s). If this is so, it is indeed, a great aberration. Every patient has the right to know what drug is being prescribed and why. You have the right to refuse or accept. Unfortunately, most people don’t know their right, so, they accept whatever the doctor (aka demigod) does/writes.

Having said that, we need to spare a thought for doctors whose handwriting are constitutionally wishy-washy. It’s not because they’re doctors; it’s just their fate. Many doctors also write poorly when they’re burnt-out. Imagine a doctor who has been on his toes for 24hours and he needs to write a urgent prescription while awaiting another doctor to take over. You just have to give him that excuse.

I did a brief literature search and found that no study has been able to affirm the claim that doctors have less legible handwriting than other professionals. The world is fast becoming paperless and medical documentation is not left out. This will help to minimise the problem of errors due to misspellings and careless writings.

WHY DOCTORS ASK “TOO MANY” QUESTIONS

If you tell a doctor that you have headache, and he simply gives you paracetamol without further questioning, check again, he might not be a real doctor. A properly trained doctor will “clerk” you, asking you numerous questions that may appear totally irrelevant to your symptom (the questions get fewer with years of experience though!). An inflammation in your knee can give you a headache. An abdominal disease can give you pain at the tip of your shoulder. You need to always remember that there are intricate interrelationships within your body organs.

A very important part of our “clerking” is called the family and social history, where we ask you not-so-medical questions. However awkward it may sound, we have to ask, and you have to answer, sincerely. We must never assume that a woman is pregnant for her husband. She may not be married yet. She may have done IVF with spermatozoa from a sperm bank. She may have been raped… All these have direct or indirect effects on her health and on the outcome of the pregnancy.

We also ask whether you drink and/or smoke. As a rule, all adults must be asked. Alcohol ingestion and cigarette smoking rank very high among the causes of almost every chronic disease existing today. I once made the mistake of skipping that part when I was clerking a woman who came to complain about infertility. But later in our discussion she volunteered the information. Surprisingly, she was a heavy smoker (up to 20 cigarettes per day). Quitting alone could have restored her fertility…

So, dear friends, next time you visit a doctor, don’t hesitate to let him take your full history and examine you thoroughly. If you don’t feel comfortable, ask for a chaperone. At the end of the day, we don’t save lives, God does.

WHAT YOU MUST KNOW ABOUT HEPATITIS B VIRUS

WHAT YOU MUST KNOW ABOUT HEPATITIS B VIRUS.

The first 12 weeks of my internship as a fresh doctor was highly depressing. I worked in the wards that were known for recording high mortality rates in the hospital. We lost patients almost on a daily basis. The mortalities were due to liver cancer, fulminant hepatitis and other forms of acute or chronic liver diseases. Majority of those patients were infected with the Hepatitis B virus (HBV).

In fact, I saw more patients dying of HBV and its sequelae, than I saw for HIV/AIDS. HBV is more easily transmitted (50-100 times) and can survive very harsh conditions for longer, than its counterparts like HIV. Signs and symptoms are also not specific: fever, malaise, abdominal pain, jaundice, etc. I just wonder why the awareness for this silent killer is so low…

More than 90% of infected adults are able to “clear” the virus even without active intervention, but about 10% become “chronic carriers”, transmitting the virus onto unsuspecting contacts. Less than 1% suffer severe, life-threatening infection rapidly resulting in death. By the time most chronic carriers present themselves to the hospital, the liver would have been damaged irreparably. The only cure for them is liver transplant, and we all know what that means…

OK, enough of depressing stories! Besides, a single article cannot possibly do justice to this topic. So, let me tell you the good news about this virus: IT IS PREVENTABLE. How?

*Avoid sharing sharp objects like needles, blades, syringes, clippers as well as toothbrushes.

*All surfaces contaminated with infected (or presumably infected) blood and other body fluids, must be sanitized with household bleaching agents (such as JIK, at 1:10 dilution)

*Avoid indiscriminate unprotected sexual intercourse. Know your (and your partner’s) status and be faithful to them.

*Ensure that blood and blood products are screened before transfusion.

*All hospital staff, paramedics, ambulance drivers etc, should avoid direct contact with body fluids, open wounds and cadavers. (Universal precaution)

*All children must receive HBV vaccination. It’s given at birth, 6weeks and 6months under the Nigerian immunisation schedule.

*All mothers should be screened for HBV ideally before attempting to get pregnant, and during pregnancy.

*Infected pregnant mothers should receive a specialised and more frequent antenatal care. Labour and delivery should also be well supervised.

*Infants of infected mothers should be given active and passive immunisation within 72 hours of delivery.

*All infected persons should be treated promptly and followed up by specialists.

*All sexual contacts and family members of infected individuals should also be screened and managed promptly.

There are huge amount of information on this topic which you can easily access. Visit trusted sites such as mayoclinic.org, WebMD and so on. See also WHO’s and CDC’s official websites.

WHEN THE PATIENT IS A DOCTOR…

I always like to make use of every opportunity to stress that, doctors ARE human beings, and we do fall ill, too. The worst part is that, our diagnosis is often complicated by an exaggerated psychological disturbance, maybe because we are “oversavvy”. For example, because I know that chest pain is a common symptom of hundreds of diseases, I would easily put myself through loads of laboratory and radiological tests just to rule out the potentially life-threatening causes. Who wants to die?!

Soon after I began my clinical training, I started feeling a strange discomfort in my chest. Kanu Nwankwo’s diagnosis of a valvular heart disease was still trending then… Dr. Okolo gave us a comprehensive lecture on cardiac pathology… Oh my God! It was as if he was talking about me. Next thing I noticed was that I was having a stabbing chest pain which radiated to my back. Then, I started having palpitations, loss of appetite and poor sleep.

I turned to my textbooks, pretending as if I was reading for exams. But I was just making sure I wasn’t going to die suddenly from heart attack, lol! When I couldn’t bear it anymore, I went to the staff clinic and met a medical officer who obviously hadn’t read as much as I had recently read then. After explaining my predicament to her, I went ahead and schooled her on what I thought the diagnosis and treatment should have been. Thank God the lady calmly reassured me that what I had was merely peptic ulcer. I still wasn’t convinced until I had an ECG which turned out to be normal, Alhamdulillaah!

Another subset of “oversavvy” patients are not actual doctors, but they have bagged PhDs from googling and “wiki-ing” every single detail before going to the clinic. Fine, it’s OK to know about the possible causes of your symptoms. In fact, it makes the consultation easier and more fun. However, it’s not appropriate to just go and tell the doctor what diagnosis you have arrived at and demand for specific prescriptions. Rather than saying, “I have malaria and I want quinine”, say: “I have fever and headache, I think it might be malaria because I’ve been exposed to mosquito bites lately”. And please, don’t carry all the articles you printed out from the internet just to argue with the doctor. That’s why it’s called a “consultation” room, not a courtroom!

MUSINGS IN THE DELIVERY ROOM

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A point is reached when a labouring woman (in the absence of pain relief interventions), no longer cares about what she says and how she behaves. It takes the grace of The Almighty and very nice and supportive delivery team for some to remain calm and quiet. This reminds me of the reaction of Maryam, the mother of Prophet ‘Eesa(as), when the pangs of labour struck her:

“And the pains of childbirth drove her to the trunk of a date-palm. She said: “Would that I had died before this, and had been forgotten and out of sight!”” (Quran chapter 19 verse 23)

It doesn’t matter how strong a woman looks; we have seen women who had opted out of analgesics or anaesthesia ab initio but later started begging for “anything” that can make the pain stop! That’s not my topic for today, but doing pelvic exercises and eating dates some days before the EDD can help to ease the pain, in shaa Allaah.

Now, one lesson I’ve learnt the hard way, is never to offer my hands to any patient for her to grab, no matter how well she seems to be coping. She can as well hold on to the iron railings of the bed. My niceness doesn’t get to that level anymore, biko! That was how one patient almost fractured my brittle bones as she clenched my hands while “pushing”. Days after, I was still applying balm and wearing crepe bandage upandan…!

On a more serious note, I think husbands should be allowed to stay close enough to the scene to hear the wailing and screaming. Perhaps, they will learn how not to complain about simple pains like that of a fishbone prick in the mouth! Lol!

Dear women, whatever level the pain reaches, please don’t curse anyone, and don’t say you will never move near your husband again. You never can tell when an angel would say Aameen. I wish you all safe delivery! Ire o.