SURGEON'S DIARY: In bid to save mother, son stabbed his father to death

It was just after 10 pm. As usual, I had watched the local news and had switched to BBC at 10 sharp to catch the international headlines. It was then to bed but that night, my routine was rudely disrupted by a call from A&E (Accident and Emergency) department of the hospital. “I have a young man with me here with a stab wound in the right side of his abdomen.”

Dr Atieno was on the phone. “He is bleeding furiously and needs to be taken to the theatre immediately.” She must have read my thoughts because just before I asked, she pre-empted me. “I know you are not on call tonight but the family knows you and requested me to ring you.” I asked her the name of the family, which she gave but it did not ring a bell. I gave the benefit of doubt to the bleeding patient and rushed to the hospital.

On arrival, I was met by Jessica, the wife of the patient, who I recognised instantly. I recalled treating her a few times in the past, as an outpatient mainly with bruises and contusions. The reasons for her injuries were invariably “knocked on the knob of the door or I fell as I was rushing in the house”.

The X-rays of the affected region were always negative. I gave her pain-killer tablets and, as I gave her the prescription, I said: “I want to see you in a week’s time to see how you are doing.” She never kept her follow-up appointment and I took it for granted that she had recovered fully and did not need to see me. I had also operated on her parents and her husband’s parents.

I waved at her and before I could talk to Jessica, I saw Dr Atieno approaching me with an anxious expression on her face. I took the hint and followed her to a cubicle inside where the patient was lying. The seriousness of the injury was obvious by the blood transfusion flowing in the vein of his forearm. A quick examination convinced me that he was in surgical shock. A blood soaked dressing on his abdomen pointed to the cause.

“What’s his BP now?”

I asked Dr Atieno the latest blood pressure reading on Marsden, whose name I had just gathered from his file, which I had glanced at to read Dr Atieno’s notes. They were very sketchy and I could understand why. He was too ill to be asked any questions.

“It is ninety over sixty,” replied Dr Atieno after inflating the cuff on Marsden’s other arm and putting her stethoscope dial in the crook of his elbow. “And this is after one pint of blood. The one he is on now is the second unit. I pushed the first unit directly into his vein,” she added.

“You are right,” I agreed with her. “The man is in severe shock and we need to stop the tap. Let us rush him to the theatre for an exploratory laparotomy.” I was referring to exploration of the abdomen and doing the needful.

“I alerted the theatre and the anaesthetist on call,” Dr Atieno was on the ball. “They are ready when we are.”

COMPLEX SURGERY

 At the operation, where I was assisted by Dr Atieno, we found multiple tears in the liver and one large one in the hepatic flexure of the colon, the part of the colon as it turns under the liver and crosses the abdomen to the left. I repaired all the tears including one in the large bowel.”

As you know the colon never heals with a simple repair because it contains semi-solid faeces which leak and cause faecal peritonitis unless we make sure that faeces don’t pass over the repair until it is fully healed,” I whispered in Dr Atieno’s ear.”

We, therefore, need to divert the faeces by giving the patient a temporary colostomy proximal to the repair, in this case a caecostomy.” Saying so, I got hold of the caecum, freed it so that it could come out of the abdomen on to the skin without tension and opened it and connected it to a colostomy bag. It was 2 am when I raised my head and looked at the theatre clock on the wall.

All our efforts in the middle of the night came to naught because Marsden did not even regain consciousness after surgery.

The bleeding from the liver lacerations persisted, the repair of the colon came asunder and Marsden did not make it. While we were anxiously struggling with him in the ICU, I saw Jessica and the family a few times. At one of these when Jessica was alone, I asked her how Marsden sustained the stab wound.

“Have you talked to Marsden?” she asked.

“He is in no condition to talk,” I replied.” That is why I am asking you.”

She took a little time thinking and then explained. “My son, Fred, is here from Leeds where he is a medical student and he had invited a few of his Nairobi school mates for a party at home. We had retired to bed in our bedroom upstairs because we wanted to give them a free hand.” She smiled and added: “We would have felt out of place anyway.

Somebody went out to smoke and in walked five thugs armed with pangas and guns. They brought the one who had gone out and tied all the youngsters after snatching their mobiles and left two of their mates to guard them. Three young men looking drugged and drunk came upstairs where we were watching TV. They ordered us to keep quiet and relieved me of all my jewellery.”

Jessica drank some water from the bottle she carried and continued her account of that dreadful night. “They asked Marsden to take them to the safe in the house and hand them all the cash. You know Marsden, he was not going to take it lying down. He refused and there was a scuffle during which one of the thugs stabbed Marsden with his panga. Seeing the blood gushing out of the wound, they panicked and ran out of the house.” With obvious relief on her face, she concluded: “I pressed the panic button in our bedroom but they had fled before the security car arrived.”

“How did you get Marsden here?” I asked.

“I called for an ambulance but seeing the heavy bleeding, my son who had come upstairs after freeing himself, decided to put his dad in the car and rushed to the A&E here,” Jessica replied.

Three days after this conversation, Marsden passed away under our watch. Fred stayed on till all the burial formalities were completed and needed my medical certificate to send to the dean of his medical school. He came to thank me before he left.

GOOD NEWS

A couple of years later, Jessica came to see me. “Fred has qualified and has decided to specialise in anaesthesia. He has managed to get on the programme at his alma-mater,” she said. “He has also decided to settle in England and does not see any difficulty in getting a consultant post after obtaining his fellowship.”

“What about you?” I asked.

“I am coming to it,” she replied. “He has asked me to join him there and I have decided to do so because there is nothing here for me except sad memories. I have come to say good-bye.”

As I emotionally got up to see her out, she pushed a slip of paper in my hand. “Herewith my mobile and email address, because you never know; you travel a lot in connection with your surgery. If you ever land in Leeds, please contact us.”

The opportunity came sooner than I expected. In an attempt to spread  their services countrywide, The Royal College of Surgeons arranged a seminar on breast cancer in Leeds. I informed Jessica and invited her and her son for dinner to the hotel where the College had put me up.

She came alone and looked very relaxed and hugged me warmly as she apologised for her son. “Sorry, Fred is on call and was called to give anaesthesia for an emergency at the Infirmary.”  In a way, I was pleased because I had a couple of questions which I knew she would find easier to answer without him.

 While we were sipping our soup, I updated her on the happenings in Nairobi. When the main dish came, I said: “You know, I never believed the reasons you gave me for your injuries. They looked as if you had been battered.” She was taken aback and was not sure how to respond. “Neither of us is on our home ground, so we can be as candid as we want to be,” I prompted her.

She was still unsure but came out with the truth. “You are right. Marsden suffered from uncontrollable rage and often hit me when he was angry.”

Emboldened by her frankness, I posed my second question which was nagging me: “The account you gave me about his stab wound; was it the truth?”

This time she took a longer pause and I had to remind her that we were still on foreign soil. This time she considered the matter for a long while and replied “No”. We had an argument and Marsden went into the kitchen and returned with a knife.

I screamed and Fred came upstairs from the party he was hosting downstairs. Seeing the knife, he tried to snatch it from his father’s hand. In the struggle the knife plunged into Marsden’s tummy. I don’t know how it happened and don’t wish to know either.”