I put this off for a long time, Chris is since well recovered, but i think it needs to go on the record. My apologies if you have read/heard this story before. The exact time frame for this blog was about June of this year
We call it helter skelter – when you shake up a bee hive or throw a snake in a room, or have a patient roll their eyes as they struggle for their last breath. Some are premeditated, but others are purely a result of sheer negligence, bordering on incompetence. This was the scene at Nsambya Hospital’s St. Gonzaga ward – as 25yr old chris mpanga suddenly suffered a bout of piercing pain in his chest.
He is admitted for the 3rd time this year, second time in this ward, no wonder a few of the nurses call him by name. This particular day, might be the last to say his name.
Chris suffered a fracture in his femur, after a boda boda RTA (Road Traffic Accident). 2 months later, he is making progress on the fracture, and has mastered the use of clutches. But this is not why Chris is re-admitted. Chris is just over 100Kg in body weight, and for the whole first month of recovery from the accident he will be at risk of Pulmonary Embolism – a condition where blood clots develop in the blood vessels, and if not treated, could end up flowing into the heart and/or lungs.
As healthy as he looks, his “silent killer” condition could result in sudden death.
Pulmonary Embolism is feared in almost all cases of RTAs where there is a significant amount of bleeding (internal), and/or deep or large open wounds. It’s advisable that victims be placed on Clexane – or any drug that thins blood, just enough to disintegrate any clots. However, Clexane may not be administered without regular follow up – and as such, all patients under this treatment have to undergo a regular (as regular as every half hour, in extreme cases) INR test, which tells medical practitioners whether or not there is too much thinning happening to the blood, otherwise it (blood) would lose the ability to perform its normal functions. Too little Clexane, would not be effective against the clots, and as such a fatal embolism could find its way to the heart and lungs.
For Chris, his 3rd admission is a result of wrongly prescribed Clenaxe medication. Granted, he is over-weight for his height, but he has taken varying dosage of this medication, from as low as 40mg to as high as 120mg. With every admission, there is a sad realization, that he was “under-dosed the last time”.
The nurses attending to Chris are not allowed to have any say, until a doctor does, and sure indeed, the last 3 doctors have given varying conclusions on his state, one even signing for his discharge! Every re-admission has been preceded with sharp pains in the chest cavity, sustained pains with every deep breath, not to mention a Doppler test that confirmed 3 large clots in his left lower limb (had a deep open wound following the accident).
This time however, Chris cant get his INR test – a worth of 12,000 UGX- because he got re-admitted at short notice (death, as a result of PE doesn’t give much notice, does it?). To think that a nurse would idly sit by, with a patient on Clexane, but with no INR test for 3 hours, as she awaits a Doctor on ward rounds to tell her what to do – is, at the very least, disturbing. After making the nurse on duty see the folly in a re-admitted patient failing to get a regular observation test over a prepaid bill that is less than 10% what we paid the last time we got wrongly discharged, I asked her, what information the almighty Doctor would use when he finally arrived, other than the usual.
Ofcourse, we both responded with a cold rhetoric stare.
Whereas surgery for Chris was successful, and whereas subsequent tests were informing, its surprising to note that there was not enough follow up in terms of treatment given and neither was there adequate dosage of any follow up medications he might need.
Of course these symptoms were more visible when Chris was still Bed-ridden, but as he got better, and started to walk on clutches, and get more angles on his lower limb joints, he has gotten better. Its a very painful realization to think that had we not been vigilant on re-admitting him, Chris might not be here with us today. He simply refused to give up, as did so many people in the family, who decided to go against all odds, to make sure Chris would get the right attention whenever he needed it.
I wonder, what that nurse would have said, had Chris succumbed to PE – that she was waiting for the doctor’s instructions? Then what would the doctor say – that had not arrived for duty? What would the hospital say? That the family failed to raise 12000UGX? Really, for a patient re-admitted because he was, admittedly, wrongly discharged twice?
Chris is a dear brother to me, and we are thankful to his surgeon, Dr. Okello, who demonstrably went out of his way to give him a good chance at recovery. Chris is since fully recovered, even dropped his clutches, retains a slight limp in his step.