Poetic justice meted out to young dad

Dr Waiganjo’s phone call requesting me to help him out with a simple cut on the leg of an eight-year-old boy initially surprised me. But, as he gave me more details, his justification to call me out on a case which superficially looked so simple became clearer.

“I would like you to please come and see Steve who has been brought from school with a cut on his leg.” As I listened to Dr Waiganjo, I looked at my watch. It was four in the afternoon. “Apparently he was playing on the games pitch, fell on a sharp stone and sustained a cut on his leg.”

“Have you stitched the wound?” I asked.

Tetanus jab

‘‘Yes, I have,” replied the doctor. “I also gave him an anti-tetanus injection and prescribed some painkillers and antibiotics.

While the mother, who rushed here after being informed by the school, was waiting at the pharmacy to collect the medicines, she noticed that the wound which I had stitched was bleeding alarmingly.

Also the site where I had given him the tetanus jab was bleeding.” The alarm bells, which must have rung in Dr Waiganjo’s mind, now chimed louder in mine.

“I see what you mean,” I said. “Please put a pressure dressing on both wounds, send his blood for coagulation profile and I am coming.”

When I entered the Accident and Emergency Department, I was quickly joined by Dr Waiganjo and the Sister, who escorted me to the cubicle where the little boy was lying on a couch. The large padded dressing which had been applied on the cut leg was soaked with blood. The smaller dressing on the arm where the anti-tetanus injection had been given looked spotted too.

Sister gently took the dressing off for us to see the state of the wounds. Both wounds were bleeding furiously. More worrisome was the observation that there was no evidence of clotting of blood, nature’s device to stop bleeding.

“Haemophilia!” I uttered the name of the cursed disease with my heart in my throat. Dr Waiganjo nodded with a forlorn expression of hopelessness on his face.

“Blood reports back yet?” I asked.

“Not yet,” Sister replied.

“We better get some more history out of the parents,” I said.

Soon a young couple was ushered into the Sister’s office where I sat waiting for them. I introduced myself and, in return, they did the same. “I am Doris, Steve’s mother, and this is my husband Roger.”

“I need to ask you some questions,” I said. “I hope you don’t mind.”

‘‘Like what?” Roger sounded anxiously impatient.

“Like have you noticed Steve getting easily bruised or developing bumps on his arms and legs with minor injuries?”

“Now that you mention it, he does,” the mother replied.

“Has he ever sustained a cut before?” I asked.

Both parents tried to recollect. “When he was cutting his teeth, Steve bit his tongue once and he bled quite a bit. It went on for a few days which I thought rather strange. Eventually the tongue healed and I did not think any more about it.”

“Have you noticed any unexplained joint swelling – say on the knee or elbow?” I asked.

This time the father’s memory came to his rescue. “Yes, once I collected him from the school after games and he had a very swollen knee. I thought he must have knocked it while playing, as lots of little boys do. He complained of pain but again it all subsided.”

“I didn’t check it but has Steve been circumcised?” It was my last question.

“No,” replied the father.

“Thank God for that,” I said. As the couple looked perplexed, I added: “If my hunch is right about the diagnosis, he would have bled copiously after circumcision.”

“The blood report is here,” Dr Waiganjo called me out of the office.

Looking at the report, Dr Waiganjo and I were devastated. “Better admit him,” I said. “See if some fresh blood of his group is available. And also order the Factor to inject into him. I better inform the parents,” I added.

“I am afraid Steve has what we call haemophilia,” I announced the dismal diagnosis to them.

“What is that?” The mother asked.

“It is a condition where some clotting factors are missing from the boy’s blood and, as a result, his blood fails to clot. If the blood does not clot, the bleeding does not stop. We are waiting for a more complete report from the laboratory to know which exact component is missing in Steve’s case. We can then give him that particular factor and stop the bleeding.”

What I did not tell them at that point were four relevant facts of great importance. One, only boys suffer from haemophilia. Two, the mother carries the haemophilia gene and transmits the gene to her son. Three, injections of Factor are quite expensive. Four, the disease is incurable, life threatening and the affected boy has to live with it.

Terrible disease

I could see that the parents were shocked. I reckoned that they had never heard of this terrible disease nor met anybody who had it. Thankfully it is quite rare in our setting. Luckily, we controlled that episode quite effectively. Steve was a model little patient. To monitor his clotting capacity, the laboratory technician had to puncture his vein often and collect blood.

Once I was there when the technician arrived wearing his lab coat, carrying his paraphernalia of needles, tubes, a rubber band to make the vein more easily accessible, cotton wool, swab and spirit.

“You want more blood, don’t you?” Steve said, stretching his elbow and presenting the back of his hand from where the blood was usually collected. His veins were not easy to locate and the technician had to puncture a couple of times. I could see Steve wince with pain but he made sure that he did not let out a yell.

When Steve was discharged, I personally counselled him. I put it all in paediatric terminology and then added: “Because your blood is incapable of clotting, please make sure that you don’t participate in activities that can cause injuries and bleeding. I am afraid swimming, football, rugby and any rough games which predispose to accidental injuries are out. You may have to concentrate on more artistic activities like music and intellectual games like chess.”

“I like both,” Steve replied, “chess and music.” Steve remained in reasonably good health. I saw him often and came to know him reasonably well. I also developed a good rapport with both his parents. So subsequently, when faced with a problem that came from an unexpected quarter, I had to lend my ear to both parties. Once I met Doris in the hospital corridor. She had come to collect medication for Steve.

“How is Steve?” I asked.

“He is alright but ...” Her voice faltered.

“But what?” I asked.

“I am not,” she replied.

Thinking that it was something medical, I asked: “What’s the problem?”

“Roger,” she replied and hesitated. “Steve’s haemophilia is putting a big stress on our married life – both emotionally and financially.”

As I was wondering how to react, she disclosed something which shocked me. “Roger has been on the Internet and has consulted specialists in blood diseases and discovered that the mother carries the gene and gives it to the son. Naturally, he blames me for Steve’s illness.”

A few weeks later, Roger came to see me and asked me searching questions about haemophilia, mostly centred on the genetic basis and general outlook of the disease. I could see that the future of the marriage was greatly endangered.

The extent of the damage became manifest a couple of years later. And it manifested itself in circumstances which were as unusual as they were sad. I was called by my obstetrician and neonatologist colleagues – both ex-students of mine. The latter is specialised in conditions affecting newborn babies.

“I did a Caesarean section last night on a woman because the baby’s head was too big for a normal delivery,” Dr Halima told me on the phone.

“At operation, I found that the baby’s head was large but she also had a big lump at the bottom of her spine.”

As I was visualising the often seen combination and conjuring the diagnosis in my mind, she added: “I had our neonatologist in the theatre and he would like you to see the baby.”

A few minutes later, Dr Wamba, the neonatologist, rang me. “I think the little girl has both meningocele and hycrocephalus and will need surgery at some stage,” he said.

At the end of my working day, I went to see the baby. “I need to see the parents and explain to them the problems their little daughter is born with,” I said to the Sister.

New love

“I told the father that you have been called in to see the baby and he is sitting with the mother in the ward waiting for you.” Saying so, she escorted me to the mother’s bed. Her face was unfamiliar to me. Sitting by the bedside was the father whose face in contrast was very familiar.

It was Roger sitting uncomfortably in the chair. As he had done with Doris in the case of Steve, he now asked various questions about the baby in the company of his new love.

“Fluid is constantly secreted inside our brain and flows all over the brain and spinal cord. When there is a block to the flow of this fluid, it collects at the bottom of the spine and gives a meningocele. Its accumulation at the top gives hydrocephalus, which is otherwise known as water on the brain.” This time I did not withhold any information. “The child will need an operation to remove the meningocele. For hydrocephalus, we put a valve to drain the fluid from the head.”

“And the outlook?” Roger asked in a glum voice.

“We will have to watch but some children with these two conditions can end with paralysed lower limbs and mental retardation.”

As I drove home that evening, I could feel the poignancy in the situation and see the poetic justice meted out to poor Roger.

Having abandoned the wife who had allegedly given him a haemophiliac son, he had sought comfort in the arms of another woman and had ended up with a severely handicapped daughter.

For retribution, one does not have to wait for the Hereafter, I mused. Sometimes it comes while one is still Here!