He died :’-(

I had gotten there early so I could get a case to clerk. It had to be a Liver case because  liver diseases was what I spent the most of the past days studying on.

I went to the files and the first I saw was the one I chose. I went with a partner and after we found him, she had said, ‘let us go for another one’. But I wouldn’t have that. I wanted this case- badly. With it, I could put all I studied into practice; find out the Symptoms and signs in a real patient, examine him in the Dr.’s presence, have him ask questions and leave a better person.

Since I was the primary owner of the case, she allowed me have it. In medicine, we seem to agree to whoever gets to decide-most of the time.

We proceeded. He couldn’t talk. His wife did the talking. After a while, his sister joined in. And there was his daughter around, as well. As we did the asking, Other Dr.s and students came once in a while to look over him. It is the kind of case that we call  interesting.

We took the history. He had been sick for 5 months.They’d come from somewhere far away and he’d been treated with herbs and getting incised by traditional doctors. When he got critical, they decided to come to a hospital. Now, he is confused and can’t talk, has lost so much weight, been vomiting, had diarrhea e.t.c

After that we joined our colleagues and had the necessary discussion on the case and another one. We were back at his bedside to examine him. The Dr. Had looked at me asking why I chose such a patient. We couldn’t examine him, he said. But we couldn’t have found all of those signs if not on a patient like him. My group members couldn’t join in but they at least like me, got a chance to see many of the signs that I have only seen in textbooks until that moment. He had palmar erythema, purpura, was deeply jaundiced, had spider nevi, tensed and distended abdomen with observable distended veins, shrunken liver and lower limb swellings and above all,was confused, signalling hepatic encephalopathy.

That was an achievement! In my studenty mind. I mean seeing all at once was great..innit? He didn’t have the contracture though..I have never seen that.

Questions on management were asked and I got to rethink all I studied.

Okay, we moved onto the next patient. That had a massive pleural effusion and after that, we were back at the Dr.’s office. Where we had a tutorial on COPD.

Done for the day, we got our books and attendance register signed. But as we stepped out of the Dr.’s office, the wailings started. OmG! My heart could have broken at that moment. I prayed! that it wasn’t him. At first I could not move to see what it was. Some of the girls had gone ahead of me and as I moved close, one of them said, ‘Amirah, it is your patient.’ I can’t describe how I felt. It was unexplainable. I was sad.

I remember his face so vividly now. I remember how his wife and children looked. I remember so well that when we went back with the Dr, there was a cute young boy and a girl who have joined the others as they were at his bedside. I could not go on to see what they looked like at that time. I just wondered how much sorrow they are in at this time and in what state he has left his wife with 5 children.

What could have been different though. I could have not taken the case and not learnt all I did and not have to feel like I lost a pt. But he wasn’t even technically my patient. I wasn’t his Dr. I was just a student. I don’t regret my before his death encounter with him. NO.He could have come to the hospital earlier instead of getting treatment at home. He may not have deteriorated into chronicity and then encephalopathy.

I wonder if anyone told his relatives that encephalopathy carried a bad prognosis and that his chances of surviving was  slim, from the start.

This is my closest encounter with a dying person. And after the whole process, I started to wonder what would have been different if we had the power to know that his time was so close. Like when it was within an hour or if the thought that the angel of death was close by, could have changed anything. Maybe that would have been the one thing to keep me away from clerking that man.

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