A short series
AT THE EMERGENCY CENTRE OF A TERTIARY HOSPITAL
Door opens and Dr Ademola, a senior Doctor walks in very fast.
"Hello Doctors!" "How many patients do we have here?" He asked.
"Four patients Chief"
(Doctors often refer to another Doctor who is senior to them as Chief)
"Can I have their histories please?, who clerked this one?" Dr Ademola asked again.
"Chief, I did sir"
"Tell me about the patient"
" He is Mr Amadi Peter, a 40yr old civil servant who presented today on account of cough of two weeks duration, breathlessness of a week duration and fever of two days duration.. "
"Stop! tell me about his chest findings"
"His respiratory rate is 28cycles per minute, central trachea, Equal chest expansion however its reduced on the left lower lung, tactile fremitus is increased in the left lower lung with dull percussion note. Other areas have resonant percussion note. Breath sound is Vesicular but bronchial in the left lower lung sir. There is also Crepitation there too"
"Is the chest Xray showing Opacities?"
"Yes sir, in that lung zone"
"What's your impression?"
"Lobar Pneumonia"
" Manage him accordingly and ensure that he is transferred to the ward later"
He walks to the next patient.
"Who is managing this patient?"
"I'm here Sir"
"Tell me about the patient"
" He is Wisdom Frank, a 40 Yr old palm wine taper who presented today on account of altered consciousness of one hour duration.... "
Cuts in...
"Has he been diagnosed of Diabetes mellitus in the past?"
"No"
"Is he a known hypertensive?"
"No"
"Any history suggestive of stroke?"
"No sir"
"What are your other findings?"
"He is currently being managed for chronic Kidney disease and on twice weekly Haemodialysis"
"Okay. What else?"
"There is a history that he has not eaten since yesterday afternoon sir"
"You are suspecting hypoglycemia. What was his blood glucose level at presentation?"
"1.2mmol/l"
"Serious! What have you done so far?"
"I tried getting an intravenous access when he presented but could not as his peripheral veins were collapsed. I got heparinized saline, withdrew some from his femoral cannulation and administered 50% dextrose. Then I replaced the heparinized saline with the volume I had withdrawn. He is now conscious with a glucose level of 7 mmol/l"
"What are you bothered mostly about in this patient?"
"Rebound hypoglycemia"
"What are you doing to prevent it?"
"I'm trying again to get an intravenous access and when I'm able, I will maintain him with 10% dextrose"
"What else?"
"I will encourage him to feed"
"Good. Ensure you counsel the patient and his caregivers so he doesn't present like this again"
"Yes chief"
Dr Ademola then walked to the next patient.
"Who do we have here?"
"He is Nse Nwosu, a 26 Yr old undergraduate who presented today on account of cough of two months duration, weight loss of two months duration, fever and difficulty in breathing of two days duration"
"Any history of drenching night sweat?"
"No!"
"Have you done chest Xray? Can you report it?"
"This is a postero-anterior chest radiograph of Nse Nwosu with Hospital number 3221 taken today. Its well penetrated as evidenced by..."
Cuts in..
"Report the lung findings"
"There is an area of cavitation in the apex of the right lung with some areas of opacities in the left lung"
"Have you done Sutum gene xpert and sutum microscopy culture and sensitivity?'
" Yes. I'm still waiting for both results to be out"
"When did you collect the samples?"
"Two hours ago"
"Gene xpert takes about two hours to be ready. Follow up with the results, once its ready and the result is positive for Mycobacterium, enroll patient for anti KOCHs at the KOCH'S clinic"
"Who do we have next?. Who is managing this patient?"
"It's Dr Usman Sir"
"Dr Usman,tell me about your patient"
"Sir, he came in with Fever and headache and has not been eating fine"
"Present your patient properly. That's not how to present a patient"
"Sir, Dr Yusuf is new. He resumed two days ago"
"That doesn't matter. Every Doctor should know how to clerk and present a patient"
"Sir, he had fever,headache and loss of appetite"
"What's the duration?"
"Six days....no..three days"
"Which one is three days?, the fever or the headache?"
"Both. I'm sorry its the fever"
"You are not sure...please clerk your patient and start management. If you have any problem, you can let me know"
Dr Ademola then strolled out of the emergency towards his office and a nurse walked fast to catch up with him.
"Excuse me Dr Ademola"
He stopped and responded.
"Hello Cynthia. How are you?"
"I'm fine. Dr Ademola, I'm not sure that man is a Doctor"
"You mean Dr Yusuf?"
"Yes. I saw him here yesterday, he was doing bizarre things"
"Bizarre things like what?"
"He gave a patient normal saline to drink when he could not get an intravenous access"
"Are you serious!"
(Normal saline is a fluid which should not be taken by mouth. Its usually given through the veins)
"Any other observation?" Dr Ademola asked.
"His prescriptions are so wrong. The duty manager is aware of this matter"
"Well, he is new, I guess with time, he will adjust"
"I don't think he is a Doctor" Nurse Cynthia insisted.
"Don't worry Cynthia, I will talk to him later. You can continue with your work. Thank you"
Dr Ademola then went to his office and sent for Yusuf immediately.
"Hello Dr Yusuf" He greeted as he arrived his office.
"Please make yourself comfortable "."How are you doing today? " he added.
Yusuf starred at Dr Ademola for a while and responded slowly.
"I'm fine sir"
"Please where did you train?"
"I trained in Nsukka sir"
"When did you graduate?"
"Last two years"
"I also trained in Nsukka. Tell me the name of the former Chief Medical Director of University of Nigeria teaching Hospital"
"Sir, I actually studied in Ghana. I'm sorry"
"You just told me you trained in Nsukka. Why the sudden change?. Anyways, what course did you study?, be sincere with me"
"I studied medicine sir"
"Are you sure?"
"I'm saying the truth"
"Well, I will inform the CMAC(Chairman,Medical advisory Council )and other consultants. We would be meeting you tomorrow".
IN THE OFFICE OF THE CMAC THE FOLLOWING DAY.
About fifteen medical consultants were present the next day including Dr Ademola. The CMAC started first
"Dr Yusuf, you started working here three days ago. Is that true?"
"Yes sir"
"Were you interviewed before you started work?"
"No"
"Were you given letter of appointment?"
"Yes.The Director of administration gave me the letter sir. The Chief Medical Director is aware sir"
"Well, what course did you study?"
"Medicine"
"Are you sure?" Another Doctor asked.
Yusuf nodded in reply. He maintained an innocent look all this while.
"If you are sincere, you will continue with your Job but if you are not sincere, you will be sacked and possibly arrested" another Doctor said.
"You need to be sincere with us" the CMAC added.
"I .... I actually studied medicine but left medical school in year three when I could not pass my exams...."
"So, how were you able to get in here?"
"My Uncle spoke to the Chief Medical Director"
"Who is your Uncle?" Dr Ademola asked
"He is a Senator"
"Is your Uncle aware that you did not graduate from medical school?" Another Doctor asked.
"No"
"How did you do it?"
"I designed a licence"
"Jesus!"
"This is the problem with this country!" Another Doctor thundered.
"This is absolute nonsense!!! How can the Chief medical Director fall so cheap to this!!"
"Giving somebody a job without due process is unacceptable!!" another Doctor who appears to be the oldest among them added.
" We must not allow this matter go unnoticed!! This is corruption!! " another interjected
"Calm down!"
"I will not calm down"
"You know how our country is"
"That's what we keep hearing!!"
"Calm down!"
" I will discuss with the Chief medical Director today "
"Oga CMAC, that will not change anything. Corruption remains corruption!"
Finally, the CMAC was able to calm the Doctors after several failed attempts.
"We accept the blame for making such a big mistake and I plead for your understanding. I will speak to the Chief Medical Director today and I'm sure something will be done about this matter. You can agree with me that this has never happened before and it will not happen again. Thank you colleagues for listening to me".
The next day, Yusuf was sacked and arrested. The news is still spreading in the hospital as I write this.
Thank you and God bless you for reading my story. It remains a fiction and has no correlation with any place or any individual.
I will loke to give a shout out to 
