The Croup
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.
Masha Allah actually the way you said that is the way Dr Kabir Abubakar is a man with integrity thank you too Dr
ReplyDeleteThis statement "I was nervous, and I marveled at his calmness as he continued to provide the child with oxygen and other conservative measures." made me remember when I was admitted at FMC Katsina and was booked for a surgery (multiple femural fracture), my dad was worried then and Dr. Kabir looked at him in a calm and confident manner and told him "he will be fine" and in the theater room, he also operates professionally, skillfully and confidently. Masha Allah, I can now walk perfectly without any sign of deformity.
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