CHRONICLES OF LIFE IN A CAMEROONIAN HOSPITAL: EPISODE 9

FROM DOCTOR IN TRAINING VANESSA FOZAO

Source: Hopital Charles le Moyne

In most cases, we are the architect of our own problems. Our decisions gravely impact the outcome of our lives. This was the case with one of my patients. A nice Saturday afternoon, we received a 60-year old man at the hospital, who was brought in by his family. His family called us before-hand to notify us of his coming, so we were prepared for his arrival.

When he got to the hospital, the man looked extremely pale with his hands placed over his chest. We laced him on the stretcher and admitted him. While performing an initial diagnosis, we realized that he had no heartbeat. In response to this finding, we started resuscitation till we recovered a faint heartbeat. He also had very low blood pressure. With knowledge of a low-pressure reading and a faint heartbeat, we went to ask his family for a more thorough patient history. 

His brother narrated that while they were together earlier in the day, the male patient was fine, and moments later after he returned to his house, he received a call from his nephew saying that his father was complaining of severe chest pain. Therefore, they decided to bring him to the hospital. With this information, we decided to get a more accurate diagnosis. We noticed a dirty bandage over his swollen left limb. We asked his brother where the bandage originated from, and he said that the male patient was involved in an accident a week prior to this incident, and he was taken to the famous Dr Bone who applied some concoctions and bandaged the limb.

We noticed that the patient was in significant pain and had notable loss of function in the left limb. The pulses permeating through the limb were faint. With these pieces of information, we made an initial diagnosis of possible pulmonary embolism, which could occur as a possible complication of a hip bone fracture. At that instance, our diagnosis was speculative, and there was no technical platform at that instance to confirm or deny the diagnosis. After discussing with the attending doctor, we decided to immobilize the limb, stabilize the patient, and refer him for better management of the limbs because we lacked anticoagulants. We explained our initial diagnosis and the situation to the family, and they agreed to comply. 

Later in the evening, I passed by his hospital room to check on him and realized that he was doing very fine, talking and laughing with his family. As soon as he saw me, he asked me when he could go home. I took time to explain his predicament to him, but he told me he felt fine and that he was sure it was a tactic from one of the people who owed him money and did not want to pay him back. No matter what I said to the patient, all fell on deaf ears, as he kept on insisting that he felt fine and wanted to be discharged promptly.  

Source: Servier Medical Art

The sad thing is that although he felt fine at that instance, he did not view things from my perspective. He thought I was not right for telling him he was in a grave medical condition when he felt fine. We turned to the family to try to convince them against moving him in order to convince him. We thought we had fully convinced them. Unfortunately for us, the next day, his family came in with a very hostile attitude and signed his discharge papers. There was nothing we could do to keep him at the hospital. A very long hour later, we saw the same car trail back to the hospital, but this time the attempts at resuscitation had failed, and the patient passed away. 

So you see, many times when people die in these situations, we as Africans often attribute it to witchcraft or sorcery, but indeed there are underlying conditions that are the cause. Pulmonary embolism happens to be one of those conditions.

PULMONARY EMBOLISM is the blockage of one of the pulmonary arteries in your lungs by a substance which has travelled from another part of your body to your pulmonary artery. It mostly results from a DEEP VEIN THROMBOSIS (obstruction of venous blood from the returning to the heart by a cloth in the leg mostly as a result of long hours in bed or long-term immobility). In certain situations, the blockage in the lungs is caused by air, fat or amniotic fluid, aptly called air embolism, fat embolism or amniotic fluid embolism respectively. Risk factors include the following: Immobility (Unconscious patients, bed-ridden patients, morbid obesity patients, post-operative patients), fractures, cancer, pregnancy, use of estrogen-containing contraceptives. Signs and symptoms include difficulty breathing (dyspnea), chest pain, rapid breathing (tachypnea), bluish discolouration of the lips and fingers, coughing up blood, cough.

Pulmonary embolisms are clinically diagnosed using an angio CT scan (sometimes an x-ray). Blood tests called D dimers help orientate towards the diagnosis. Treatment mostly consists of giving anticoagulants or removing the obstruction.

The lesson here is that we should take our health more seriously because health is wealth. Also, we pray the government better equips our health facilities because one of the reasons we were not taken seriously was because we could not do any tests to actually confirm our preliminary diagnosis. In addition, this should help educate the public on the symptoms and manifestations of embolisms. Thank you for reading!