Case of attempted suicide as husband divorces wife

Every hospital in Nairobi has “On Call” roster for all specialties and  doctors accredited to the hospital are on it. This roster takes care of emergencies which arrive in the hospital day and night. Usually, the patient is given the choice of naming his or her specialist, if they have one.

Also these days, many patients have private insurance and the insurance company designates a doctor of its choice to treat its client with an emergency illness. There still remains a pool of patients who need the services of a specialist on call and the doctor on the roster fills that need.

During my active years in surgery, my “On Call” day was Tuesday and it stretched from 7am to the same hour on Wednesday. I chose Tuesday because it was my operating day and since many surgical emergencies required an urgent operation, it was easy to fit them in my operating schedule.

It meant that I did not accept any social engagements on Tuesdays and if I did, under pressure, I warned my host that I might have to leave suddenly, if I was called by the hospital. As it so happened, one Tuesday evening while Marie and I were helping ourselves from a splendid buffet, my mobile sprung to life.

“Dr Muturi here, sir,” one of the doctors from the Accident & Emergency started in his usual polite manner. “I have Mrs Yvonne Ouko here with a severely injured leg as a result of a road accident.” As I brought my mobile closer to my ear because he sounded faint, Dr Muturi continued. “The limb is badly crushed and its circulation is compromised. I think that Yvonne needs an urgent amputation.”

That was enough information to make me run. I left my delicious dinner and apologised to my hostess, who, looking at my untouched plate said. “I am sorry that you have been called before you have eaten.”

“Don’t be sorry,” I said. “I have been called away from more intimate moments of my life!”  I arranged for Marie to be escorted home by a guest – she had got used to the lot of a surgeon’s wife – and drove to the hospital.  I saw Yvonne there with Dr Muturi and the night Sister. Dr. Muturi gave me some more details of the accident, as we walked to the patient’s bed. I examined her and her injured leg.

LIFE OR LIMB

I could not feel any pulsation in the popliteal fossa, an anatomical landmark behind the knee, nor in front of the ankle. My findings confirmed our impression that the femoral artery had been severed somewhere in the thigh, causing death of the limb below.

“I am not having my leg off.” Yvonne  said when I gently suggested amputation of her right leg.

 “It is a question of removing your leg to save your life.” That stark choice and persuasion by Yvonne’s husband, Shadrack won the day. But Shadrack had his own argument, when I tried to take him into confidence when Yvonne proved refractory to reason. “If the main artery has been severed, why don’t you repair it and save my wife’s leg?” he asked.

“We can,” I replied. “ The leg is cold and has lost all its sensations, so repairing the artery will not revitalise the leg. Moreover the bones are badly splintered and the muscles are torn, endangering her life. So when I said life or limb, I was not being melodramatic. I was stating the facts.”

That talk went home and Yvonne signed the consent form, albeit most reluctantly, allowing us to remove her devitalised leg. Her postoperative course was uneventful and her learning to walk on crutches, while she waited for her prosthesis highly successful. Once when I did not find Yvonne in her bed on my ward round, I was told by the Sister that she had gone for her exercises, I walked over to the physiotherapy department and saw her there.

To encourage her, I stated a fact.”Your husband wants you to have the best artificial limb and I have sent your measurements and photograph of your amputation stump to Roehampton in England, which is considered a top prosthetic centre in the world.

In time the prosthesis arrived from Roehampton and after a few more sessions of physiotherapy, Yvonne became quite agile on it and went home. After few check-ups in my office, I discharged her with  satisfaction of a job well done, a feeling I shared with Yvonne and Shadrack.

Until one evening, I was rung up by a doctor. “This is Dr Kagika in the A&E,” he said. “I know that you are not on call today, neither do you need to rush here.” As I was wondering why he was calling me, he went on.

“I wanted to inform you that an old patient of yours has been brought here as a case of attempted suicide by taking too many sleeping pills. I called Dr Osir, our physician on call, who has admitted her after we gave her a stomach wash and started her on a drip with drugs to revive her.” As I was still not clear where I came in, Dr Kagika provided the missing link. “On going through her old file, we noticed that you did an amputation on her a couple of years back and thought you would like to know.”

BEST PROTHESIS

“What’s the name of the patient?” I asked.

“Yvonne Ouko,” replied Dr Kagika.

“And what does Dr Osir think about the prognosis?”

“Excellent,” Dr Kagika said to my relief.

“Lot of ingested tablets were still in the stomach and came out in the stomach wash and Yvonne was coming out of her coma before she was transferred to the ward.”

I thanked Dr Kagika and asked him which ward Yvonne was going to. I walked over there after finishing my surgical assignments the next morning.

“Fancy giving me a shock like this.” I said with feigned annoyance on my face. “How you feeling now?”

“Do you feel like telling me what drove you to it?” I walked on egg shells.

“Sure,” she replied. “My husband.” “Do you remember that he asked you to get the best prosthesis for me?” As I nodded, she went on. “He forgot that even the best artificial limb has to be removed at night.”

“So?” I goaded her, burning with curiosity, as she fell silent.

“To cut a long story short, he found me repulsive without my artificial limb and found solace with other women.” As I was surprised with this new cosmetic aspect  Yvonne added. “I noticed the change in Shadrack since a year and had to ask my doctor to give me something to help me sleep. We have been bickering about till that night when in desperation, I gulped all my sleeping pills.”

Being a case of attempted suicide, Dr Osir and I decided to refer Yvonne to our psychiatrist.  I sat in the first session between Dr Okello and Yvonne because I wanted to learn the psychological effects of mutilating surgery on the patient and spouse. Looking at me, Dr Okello said to Yvonne. “I have seen the husband finding the wife unattractive after a mastectomy but yours is the  first case after an amputation and ending in such extreme consequences.”

As the session continued, I heard him say. “Remember, no man is worth giving your life for and Shadrack can’t be the only fish in the pond.” Admiring her figure he went on. “You are an attractive woman and should have no difficulty in finding another husband, who loves you as you are.”

Then he added a very salutary remark, which by virtue of its originality has remained etched in my mind. “It is easy to court and marry a man with your handicap because he knows what he is getting and does not feel cheated later on.”

The last sentence touched Yvonne’s heart as much as it did mine. Now, five years later after that sad incident, Yvonne and Shadrack have divorced amicably and they are both happily remarried.

Yvonne brought her new husband to meet me and I found mutual love lurking in their eyes as they looked at each other and conversed. As evidence in favour of the wise opinion from my psychiatric colleague, an erstwhile student of mine, when Yvonne removed her prosthesis at my request to show me her amputation stump, I kept looking at her new husband’s face and did not see an expression of any repugnance or revulsion.