SURGEON'S DIARY: Two deaths on couple’s dark wedding anniversary

“The patient is too badly injured to give a coherent history and her husband, who is with us here, has a language problem. He neither speaks English nor Swahili,” Dr Obed said on the phone to explain his inability to provide more details about the accident.

“Okay,” I said recognising the seriousness of the injuries sustained by the patient by what he had told me already. “I will be with you soon.”

It was past midnight and the roads to the hospital were relatively quiet. It was so different from my usual journey to the hospital every morning and back home every evening, when the mind is busy concentrating on matatus, large trucks, buses like

behemoths and some mad commuters driving alongside.

The concern is to prevent one of them knocking my car and driving off. It was a pleasure to drive at that hour of the night and since I was called on my mobile, the empty roads activated my memory to recall how the devices to summon a doctor have

changed in my time as a surgeon.

When I was a newly qualified intern in the renowned JJ Hospital in Bombay, a ward orderly was sent to call the doctor on call. I remember him carrying a clipboard, on which was written a message from the Sister of the ward, who wanted me.

When I worked in the UK, I found that in small hospitals, the switch board located us by phoning the wards and common areas like the lounge and the dining room.

OLD METHODS

In larger hospitals where there were many resident doctors, multi-coloured lights were installed in all the units and each doctor had a combination of colours, acting as his or her individual code.

This was followed by the era of pagers which worked like a voice mail. We all, both senior and junior hospital doctors and GPs, had to carry them in our pockets. It only carried the message of the caller.

Then came mobile technology and cell phones became our constant companions.

It is a blessing to ward sisters and resident doctors, who can now talk directly to consultants, obtain advice and save valuable time in emergency situations.

I had arrived at the hospital by the time I had recounted the evolution of the call system for the doctors. “Since I rang you, I have done a peritoneal tap on the abdomen of our Chinese lady and aspirated frank blood,” Dr Obed said when we met.

To my good luck, a compatriot of the patient had arrived. He spoke fluent English and was there to translate for us. “I am Mr Tao and this is my friend Mr Jin, who works on the road constructions going on in Nairobi,” he said pointing at the dazed looking husband.

“He tells me that it was their wedding anniversary today and to celebrate it, he took his wife to an Indian restaurant, which serves her favourite ethnic food. It was while they were returning home that his car met with a terrible accident.” He paused and

listened to Mr Jin and then continued.

“The wife was seriously hurt but he came out unscathed.” As I saw Mr Jin speak emotionally with a lot of gestures, the interpretation stopped abruptly.” What is he saying?” I asked.

“He feels very sorry and wishes that it was the other way round.”

PATIENT WAS PREGNANT

As I got up to go and examine the patient, the interpreter touched my white coat and added:“My friend wants you to know that his wife is three months pregnant and this is her first pregnancy.”

On examination, I found Mrs Jin looked very pale and was in dire straits. She was alive only because of all the resuscitative measures Dr Obed had put in place.

There was no doubt that she had serious intra-abdominal injuries and a quick ultra-sound confirmed the enormity of the damage inside. Time was of the essence and I took her to the operating theatre as soon as her clinical picture stabilised. As expected, the abdomen was like a battle ground.

The spleen was in shreds and was bleeding furiously, necessitating its removal. The liver was in the same state and I repaired it. I checked the uterus and confirmed a three-month-old pregnancy. 

Two problems, however, remained and caused great concern. The pancreas was badly squashed against the spine as a result of the accident and I did not think that the gravid uterus would retain the pregnancy and feared that it was likely to eject the foetus after the shake-up. As I came out of the operating theatre and walked to the doctors’ car park, the sun was rising in the beautiful sky, painted in brilliant hues. The birds were chirping in the trees and raised my spirit after dealing with a sad case.

Mr Jin and his friend were waiting for me. “Mr Jin wants to know what you found,” Mr Tao requested.

I gave them all the details and also conveyed my two concerns to them. In reply, I got the usual refrain. “He is very upset about the whole thing. He says that he will never be able to forgive himself if something happened to his wife or their unborn baby,” Mr Tao conveyed the message.

Unfortunately both my fears came true. My gynaecological colleague, Dr Kago, who was helping me with the pregnancy, rang me one night and informed me: “I can’t hear the foetal heart sounds. I am getting an ultra-sound done and if the foetus is dead, which I believe it is, I will have to carry out a D&C.” He rang me in the morning to say he had done it.

I told Mr Tao about the sad development and he conveyed it to Mr Jin. He seemed very agitated and kept on repeating. “I will never forgive myself.”

The bigger blow which followed a couple of days later stunned us all. The traumatic pancreatitis took its toll.

I had noticed, at surgery on Mrs Jin, her pancreas looking like a piece of moth-eaten cake because of the haemorrhage which had occurred in it as a result of the blunt abdominal injury.

In spite of heroic efforts by my team and various other specialists, whom I had called to help me, we lost Mrs Jin. Her husband was devastated when I broke the news to him. Even though he was constantly blaming himself for the accident, perhaps he had not emotionally prepared himself for the likely final outcome. Overawed by the busy activities in the ICU and the high powered technology employed in the management of his wife’s case, it had never occurred to him that our efforts could prove futile.

BLAME HIMSELF

On hearing of her death, he broke down completely. Coherence to his emotional outburst was given by Mr Tao who translated it and said on his behalf.

“I will never be able to live with this, losing my wife and our first child on our wedding anniversary, caused by a road traffic accident, for which I was responsible.”

Perhaps he meant it. A year later, I was rung by Dr Tanui, the Casualty Officer. Dr Obed had finished his term in the Accident and Emergency department and had joined the post-graduate surgical programme and was on his way to qualify as a surgeon.

“I have a man here, brought in by the police. They found him on the Uhuru Highway. They tell me that the car is a write off.” He took a little pause and added.

“As I see the patient, he is no better. He is semi-conscious and breathless, suggestive of serious head and chest injuries. I did a peritoneal tap because his abdomen is rigid like a board and aspirated frank blood.”

“Alright, I am rushing to the hospital. I am sure you have given all resuscitative measures,” I said and, without waiting for a reply, I drove to the hospital at break neck speed, with an alibi ready in case the traffic police stopped me. On arrival, Dr Tanui escorted me to the ICU, where he had transferred the patient after ringing me. I did not have to stretch my memory too far to recognise him.

He had no difficulty in recognising me either. On his face was a defiant expression, to understand which, I did not need the services of Mr Tao. It clearly said, “I told you so. Didn’t I?”

UNCANNY FEELING

He died under our very eyes. I had an uncanny feeling, so I looked up his wife’s file in my office, the next day. His date of accident was the same as his wife in the previous year. It was once again their wedding anniversary.

Being a death after a road traffic accident and cause of death unexplained, a post-mortem was mandatory, which I attended.

We found that Mr Jin had died of multiple injuries. He had contusion of his brain and a right collapsed lung from multiple rib fractures. Inside his abdomen, the picture was identical to his wife’s. His spleen and liver were badly lacerated and he had traumatic pancreatitis.

Prof Waweru declared Mr Jin’s cause of death as multiple injuries and listed all the above. That was undoubtedly the physical cause of death. What the good professor had no way of knowing and what she left unsaid was really the crux of the matter in this case.

Was Mr Jin’s death accidental or suicidal? I had an eerie feeling that in view of what Mr Jin had repeatedly told me, while I was dealing with his wife’s fatal case, he had killed himself and done so with a fantastic sense of timing.