The Croup

The Croup

In my career in Medicine, I have seen many challenging patients. I remember one particular little girl in my early years. The dedication and skills of the doctors treating her made a great impression on me. This is her story.

It was 1990, and I was doing my internship year after graduating from medical school. I was at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria. Our Internship was also known as the ‘Housejob’ and involved us rotating in the different departments of Surgery, Pediatrics, Internal Medicine and Obstetrics and Gynecology.

After 3 months in Surgery, I had come to Pediatrics. My good friend and former classmate Kabir Abubakar had already been in Pediatrics for a couple of months and quickly showed me the ropes. He took me around the EPU (Emergency Pediatric Unit) and introduced me to the patients. He taught me how to calculate doses of medications for these small children and how to obtain intravenous lines.

Kabir was my friend, and also a great teacher. I had a good first day, but towards the evening, we heard a small commotion in our intake area where the Pediatric emergencies were brought. It was a frantic Mom, with her 4-year-old daughter. Her daughter had developed a cold followed by breathing difficulties.

Both Kabir and I rushed to her side. She was having difficulty breathing. We diagnosed croup with epiglottitis. This is an infection of the trachea that can become serious in small children. We tried conservative measures initially, but she was not getting better. We called our anesthetist to intubate her. Intubation would be difficult as she was so small and likely had inflammation in the trachea.

While waiting for the anesthetist, Kabir told me that we should be ready to do an emergency tracheostomy (a small hole in her neck) if she gets into acute distress. Have you done one before, I asked him. No, he said, but this is an emergency, and he had his scalpel ready. He also told me to have a large bore needle we could stick in the trachea as an alternative. I was nervous, and I marveled at his calmness as he continued to provide the child with oxygen and other conservative measures.

Suddenly the Anesthesia team showed up. They rushed the child to the Operating room and intubated her. She was subsequently moved to the Intensive Care Unit. With her airway restored she became much more calmer and was breathing comfortably. Eventually, she was taken off the ventilator and remained comfortable with the breathing tube in place.

Our Pediatrics team continued to follow the patient. During this time Kabir rotated off Pediatrics, and was replaced by another close friend and classmate, Adoyi Ameh. At this time, an attempt was made to remove the breathing tube, but she immediately went into respiratory distress and had to have the tube reinserted.

Another course of antibiotics and steroids followed, but she again failed attempts to remove the tube two more times. Subsequently, our team decided to see if she could be evaluated by an Ear Nose and Throat Surgeon. Unfortunately, we did not have one on staff at that time and we decided to take her to see one in the nearby town of Kaduna.

We arranged an ambulance to take her there, and our senior registrar decided that one of the house officers will accompany her. I was chosen even though that would mean that poor Adoyi would be manning the Emergency Pediatric Unit alone at the height of the meningitis epidemic. However, Adoyi is an amazing guy and with great grace, simply said “Go, I will take care of everything here”.

So, I sat in an ambulance for the first time in my life for the one hour ride. We saw the ENT doctor who said he could do a tracheostomy, but said he did not have the ability to provide her the care afterwards. Defeated, I came back to our hospital. Adoyi had managed all the admissions alone for that day superbly.

Our Surgical team then decided to do the tracheostomy and take out the tube themselves. The child did very well and was able to be eventually discharged home. At a subsequent follow up, the tracheostomy tube was removed and the child made a full recovery.

About a year later, I was walking in the local Sabon Gari market, when I heard an excited voice shouting ‘Doctor’! I turned around and it was the mother of the child. I asked her how her daughter was? She turned around to show me the clothing store she ran in the market and inside was a happy little girl playing. A small scar on her neck was the only reminder of her illness. The Mom thanked me profusely. I reminded her that I was just a small part of the large team of doctors that took care of her daughter.

Kabir went on to become an Orthopedic Surgeon, Adoyi Ameh a Pediatric Surgeon. I came to America and became an Infectious Disease Physician. I will however never forget the selfless way in which all those doctors came together to help this child who is probably a grown woman today.

Zia with Kabir in the EPU 1990, inset is Adoyi Ameh.

Walo Black

Walo Black

On October 1^st 2004, my dear friend Auwal Abubakar was killed in a car accident along a highway linking the cities of Kaduna and Kano in Northern Nigeria. This was devastating news for me as he was very dear to me. Amongst my many memories of Auwal is one that involves the same highway on which he eventually lost his life. Here is that story.

We called him Walo in our class tradition of having nicknames that ended in “O”. I was thus “Sifo” (from Asif). However, we had another Walo in our class. In order to differentiate them from each other, one became “Walo black” as he was slightly darker complexioned and the other became “Walo white”! While both were my close friends, this story is about Walo black.

It was in 1990, and I was doing my house job at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria. The hospital assigned us apartments with two house officers to an apartment. Walo was my roommate. While we rotated in different departments, we were both posted to the Internal Medicine rotation at the same time. I moved to Obstetrics and Gynecology from Internal Medicine. Auwal (Walo black) had now moved to Pediatrics.

I had gone to the Internal Medicine office to pick up my evaluation. The secretary asked me if I would take Walo’s evaluation to him as well as he had not picked it up and he was my roommate. It was sealed in an envelope, but with a twinkle in her eye, she told me that his evaluation was much better than mine.

I loved Walo, but in order to punish him for doing better than me, I decided to play a trick on him. I went home to my portable typewriter (we did not have home computers in those days) and typed up a letter.

The letter was addressed to Auwal Abubakar from the Medical and Dental Council on a plain piece of paper (of course I did not have their letter head). It said to the effect that “We are sorry to inform you that because of your poor evaluation in Internal Medicine (attached), the Medical and Dental council regrets to inform you that your medical license is cancelled”! I signed it with my own signature and enclosed both his sealed evaluation and this letter in another envelope and put it in his mailbox in the Pediatrics department. It was such an obvious forgery, and along with his good evaluation, I thought we will both laugh about it later.

Unfortunately, it did not go as planned. Later that afternoon, I ran into Walo in the hallway in the hospital. He looked very unhappy, and he instantly accosted me and said in an aggrieved tone “Do not Laugh”! Confused, I said, Laugh at what? You know what you did he said in a severe voice. What happened I asked?

Apparently Walo had got to his mailbox that morning and read the letter. He saw his perfectly good evaluation and felt very upset at the letter supposedly from the medical council. He went immediately to his Pediatrics team and told them about the letter and that he had to go to the office of the Medical and Dental council right away to sort this out.

Unfortunately, that office was in the neighboring town of Kaduna, which was an hour bus ride away along the Kaduna - Kano highway, (which passed through Zaria). He left for that office immediately by bus. After a long hour in a crowded bus, he got there and started arguing with the staff there as to how dare they send such a letter for a perfectly good evaluation.

The Medical Council told him that they had issued no such letter. It was then Walo took a proper look at the letter and realized it was fake. He saw my signature and knew that I was responsible for this deed.

To add insult to injury, when he got back, he had to tell his Pediatrics team what had really happened, and they burst out laughing. Instead of getting sympathy, everyone was laughing, and Walo was mighty upset at me.

I did not laugh at that time but apologized profusely. I told him I never imagined that that he would not realize it was fake. I had even signed it with my name! In the end he forgave me, and as penance, I took him out to dinner at our favorite restaurant “Shagalinku”.

We did laugh about this afterwards. I eventually left for America and lost touch with him. Walo became a specialist in Pediatrics and was a Consultant at the time of his tragic death. It was the same highway, but this time he was going the other way towards Kano.

I pray that his soul rests in perfect peace.

                                              Walo and Me at Graduation in 1990