The Pandemic

The Pandemic

In December last year, we had been hearing of a new virus called Covid 19, that had been causing a flu like illness in China with many deaths. In February we started of hearing of cases in the United States. In March I saw my first patient.


Being an Infectious Disease doctor with an Epidemiology background, people started asking me questions on how to treat this. Unfortunately, this being a completely new virus, I did not have much advice. I did try to follow the studies out of China and Europe judiciously.


One study out of France suggested using an antimalarial drug called chloroquine. I was very familiar with chloroquine having used it both personally and on patients in West Africa. It was not clear why this would be effective. This drug does have an immunological effect and one reason for death in these patients is an immune phenomenon called adult respiratory distress syndrome. Perhaps chloroquine was able to control this?


We started using this on our patients along with other supportive care. The first patient did very well, and recovered completely. The second patient developed complications and despite heroic efforts by our in-patient team, he died.


At this time, my hospital got a call from a national medical TV show. The patient who had recovered had been giving interviews of how he got better on chloroquine. They were interested in talking to me especially if I had used chloroquine before. My hospital arranged an online interview.

In the interview I told them that I did not know if chloroquine helped or not as one patient had recovered and one had died. They must have been unhappy with my answer, as the interview never aired. Subsequent studies appear to show no benefit from chloroquine and I stopped using it.


The epidemic continued relentlessly. We had a few more patients die and several recover. I was instructed to start consulting on patients via telehealth to limit the number of people in the hospital as well as to  protect me. The virus is unpredictable with some elderly patients with multiple problems doing well, and some younger and healthier patients not doing so well.


One scene will always live with me. Earlier in the epidemic, I had come to the ICU to see a critically ill Covid patient with multiple medical problems. The family had however decided to make him comfortable and the ventilator had been removed. He was dying all alone.

It was at that time that three of the nurses put on their personal protective equipment and went into the room with him. They stood around him, one of them holding his hands until he passed. The sight of those nurses standing quietly by this patient so that he would not die alone touched me deeply.


I do not know how this epidemic will end, but one thing I do know for sure is that it will not rob us of our humanity.

Me in Personal Protective equipment in March 2020

The Migrants

The Migrants

June 20th is world refugee day. Recently, I was reading about the sinking of yet another boat taking migrants from Africa to Europe. This time it was a boat taking West African migrants to Greece. The boat sank, and many lives were lost. Men and women mostly young people in search of a better life. Those that do make it across have further daunting challenges. Seen as nuisances and illegal, they are often locked up in internment camps for years before being deported back home.

The circumstances were different a generation ago. I was seeing an elderly patient of mine today. He became excited when I told him I had grown up in West Africa. He was born in the small Greek island of Kefalonia. He was 18 when in August of 1953 a major earthquake hit that area. Many were killed and most homes were destroyed.

My patient had lost his home and was sleeping in the open. There were no jobs. It was then a cousin convinced him to come to Africa where a family member was running a store. My patient made it to Rhodesia (current day Zimbabwe). He started in business trading in goods all over Africa, and was quite successful. He has very fond memories of those days in Africa remembering it as a beautiful place with wonderful people.

I had grown up in Nigeria and was reminded of another famous Greek merchant there, Anastasios George Leventis. Mr. Leventis moved to Nigeria in the 1920’s from Cyprus and was very successful as a trader. He eventually established the Leventis chain of superstores which were found all over Nigeria.  I remember going to these stores while growing up. 

Mr. Leventis was very friendly with the leaders of newly independent West African states such as Ghana’s Kwameh Nkurmah, who appointed him as Ghana’s ambassador to France. Mr. Leventis died in 1978. After several years his stores eventually closed down, but the A.G. Leventis foundation remains active and provides many charitable activities.

As for my patient, he eventually migrated to the United States in the 1970’s and settled down here. He subsequently got married and had children and grandchildren. He is in his seventy’s now and loves talking about his time in Africa.

However with time, things have turned full circle and migrants are now going the other way to Greece and other European countries from Africa.

I wish that a day will come when no one is forced to migrate for economic or other reasons.

Old Leventis Headquarters in Lagos, Nigeria

Nicknames

Nicknames

I went to medical school at the Ahmadu Bello University in Zaria, Nigeria many years ago. My classmates were a varied bunch of people from different places, different ethnicities, different languages and so on. Yet, the rigors of medical school made us bond for a lifetime. Even today, when many of us have not seen each other in so many years, those bonds remain.

One way we marked our kinship was to give nicknames to each other. Some of these were as simple as shortening the name and adding an ‘O’ at the end in true Northern Nigerian style. I thus became Sifo (from my first name Asif). David became Davo, Isiyaku became Skimo, Mikhail was Miko and so on. Auwal became Walo, but we had two Auwals in our class, so we differentiated by calling one Walo white (slightly lighter skin tone) and the other Walo black.

Some names were initials. We had a CCC (CC Okafor), IYV (Isah Yahyah Vatsa), MSS (Mohammed Sani Shehu) and MBD (Mohammed Bello Dikko). Some were a corruption of the actual name (Ado Zakari Kudan became AZ kudanese and Zara became Zarams). Temple was always known as Temples. Even he does not remember how the S was added to his name.

Some names were based on a certain character of the person. Prof (Emmanuel Ameh) got his name because of his immense knowledge. Iliya Jalo was always smartly dressed and his boyish good looks got him the name Oyiboyish. Goli was short so he was called Brevis and his close friend Agaba was tall, so he was called Longus (from names of muscles in the human body).

Not everyone had nicknames of course, but our bonds were just as strong. So many years later, I still remember my brothers and sisters as it were yesterday. We are scattered all over the globe and practicing medicine in different specialties, but remembering those nicknames we had for each other brings back wonderful memories. 

To me these names represent an amazing fellowship that we had so many years ago that I miss dearly today. Here is a list I made as to the best of my memory;

1. AKA -Alakija Salami
2. Alhaj Bobo -Kabir Sabitu
3. Anastomosis -Moses Audu
4. Ayour -Ayo Oyewo
5. AZKudanese -Ado Zakari
6. Brevis -Lamar Goli
7. CCC -CC Okafor
8. Chi Chi -CC Ekwempu
9. Computer -Ibrahim Mohammed (IM)
10. Davo -David Ewaoda
11. Frikkado -Farid Tahir
12. Fusco -Furera Sule
13. Geeno -Mohammed Yakubu
14. IYV -Isah Vatsa
15. Jugul  -Bitrus Danboyi
16. Lizzie -Elizabeth Ogboli
17. Longus -Emmanuel Agaba
18. MabJo -Mela Mansfield
19. Mallam -Ahmed Yakubu
20. MBD -Bello Dikko
21. Medo -Ahmed Girei
22. Miko -Mikhail Yusuf
23. MSS -Sani Shehu
24. Mr. T -Taiwo Irinoye
25. Nash -Ibrahim Nashabaru
26. Oyiboyish -Ilya Jalo
27. Prof -Emmanuel Ameh
28. Ralour -Tony Akpotabore
29. SamP -Sam Epelle
30. Sankas -Robert Sanda
31. Sifo -Asif Zia
32. Sikkiways -Sikiratu Kailani
33. Skimo -Mohammed Isiyaku
34. Temples -Amaefulla Temple
35. TSW Anya -Daniel Tswanya
36. Verna -Veronica Ubakanma
37. Walo black -Auwal Abubakar
38. Walo white -Auwal Abubakar
39. Zarams -Zara Mairami

Faculty of Medicine, Ahmadu Bello University

The Consult

The Consult

It was spring and I had just returned home from a long day at work, when the phone rang. It was my mother calling from Florida. My father had taken ill suddenly and had to be rushed to the hospital. He was in his eighty's and had been in poor health for a while. He had heart disease and Diabetes and had been undergoing treatment for diabetic foot ulcers.

I called my sister who lived close to them. She was in the hospital with him. She said it did not look good. Both his heart and kidneys were failing and he was being admitted to the intensive care unit. I immediately arranged for a flight to Florida the next day. My brother and other sister were also rushing there.

The next day all four siblings met at my father's bedside in the hospital. It had been several months since all the siblings had been together. The doctors told us that he had suffered another heart attack, and this time he had badly damaged his heart. His heart was failing and his kidneys were failing too. He continued to decline and having difficulty breathing. After three days in the intensive care unit, we as a family decided to make him primarily comfortable.

He was placed on morphine and moved to a regular room. He looked much more comfortable and we all took turns staying at his bedside. He was then moved to a hospice center. I was sitting next to my father in a darkened room. He looked quite comfortable, and I was reflecting back on his life, when suddenly I received a text message on my work phone. It was from one of our resident doctors back in North Carolina.

He had an interesting patient. It was a visitor from Africa, who had come down with Malaria. I was the only Infectious Disease physician in my hospital and thus the request for advice. I texted back my suggestions for treatment. Doing this actually helped me deal better with my father's illness. Early next morning my father passed away peacefully in his sleep. I and one of my sisters were at his bedside.

After this, we got busy with funeral arrangements and taking care of my mother. My colleagues at the hospital were very kind and send many condolences. One of the residents at the hospital even got a collection of money from the other residents and made a donation in my father's name to the Diabetes foundation. They also arranged for a tree to be planted in his name at a state forest. I was very touched by these gestures.

The day after the funeral, I thought about the Malaria patient again. I had the ability to do a 'teleconsult' using my phone and a tablet computer at the hospital via a secure connection. Medical residents and my physician assistant would examine the patient, then connect me online, so I could directly communicate with the patient.

I did do the consultation and speak to my patient. While he was from Africa, he was of Indian descent. He reminded me of my father, who spend decades in Africa but was also of Indian descent. In a strange way, taking care of him helped me deal with my Father's death. The patient was doing better and the malaria parasite had been cleared from his blood.

Our patient told me that he had come to our small town in North Carolina because apparently this was a manufacturing center of agricultural equipment for the type of large cotton farm he ran in Africa. He was subsequently discharged and went back to his hotel room in town.

A few days later, I was back at work. In the hospital we were consulted again on our Malaria patient. Back in his hotel he had developed abdominal pain with persistent nausea and vomiting and been readmitted. The scan of his abdomen showed a significantly enlarged gall bladder.

At our consultation, we determined that his gall bladder enlargement was a complication of his malaria. The malaria had been cleared, but he had developed this condition called “acalculous cholecystitis”. This is a very rare complication of malaria.

We asked our surgeon to remove the gall bladder, which he did. After the surgery, our surgeon told us that the gall bladder had been removed just in the nick of time as it was close to rupture. Our patient made a complete recovery and eventually went back to Africa.

This was a very rewarding experience for me. Watching this patient's complete recovery helped me heal from losing my father.

I hope this patient continues to do well and is successfully running his farm today.

                                                    

Anopheles mosquito carrier of Malaria

The Akan Man

The Akan Man

I was rounding in the hospital recently when one of our Physician Assistants approached me with an unusual request. She asked me to cosign a consent form for a toe amputation on a patient as he was unable to give the consent himself.  This was an unfortunate case and here is his story.

Several months ago, a man was brought to our Emergency Room. He had been left at a local clinic by two men with whom he worked with on a farm. Those men disappeared soon afterwards, and the clinic sent him to our hospital. The only history we were able to obtain was that this man had become confused and walked outside into a grass fire, developing burns on his feet. He was unable to speak and appeared not to understand what was said to him. He was in his late fifties.

The medical term for this was expressive and receptive aphasia. The Emergency Room made sure he was not under the influence of alcohol or drugs and a CAT scan of the head confirmed a diagnosis of multiple strokes. A recent stroke had affected his speech and ability to understand any spoken words.

He was subsequently admitted to the hospital for further treatment of his strokes and his burnt feet. He had a brief period of lucidity in which he was able to state that he was a farm worker originally from Ghana in West Africa, and his mother tongue was the Twi language. He had no family in the United States. He was unable to explain how he ended up working in the small farm in North Carolina.

I have grown up in the West African country of Nigeria, but I had never heard of the Twi language. I looked it up. It is a language of the Akan people of south and central Ghana. It is a dialect of the more well-known Ashanti language. It is spoken by 6 to 9 million people.

The hospital was able to get a translation service with a Twi speaker on the phone. Unfortunately, that was not very useful as he still could not speak any words and appeared not to understand what was said to him. He had no social security card or any legal papers. His foot had developed gangrene in some toes, and these toes needed to be amputated. However, we could not communicate with him to obtain consent for the surgery.

I was asked to see him for Infectious Disease consultation about the gangrene in his feet with possible infection. I was able to advise on antibiotics, but he still needed an amputation.

The hospital social workers contacted the embassy of Ghana who offered no help. Department of Homeland Security as well as the United States Immigration services were equally unhelpful. In the end, the Physician Assistant taking care of him in the hospital asked me to be one of the three physicians to co-sign the consent form on his behalf.

I signed the consent form along with two of his other physicians and finally on the 98th day of his stay in the hospital, his gangrenous toes were removed. He was able to walk around but was still unable to speak and does not appear to understand anything said to him, even through the Twi translator.

Our discharge planners worked tirelessly trying to get him to a nursing home. However, without any legal papers, those homes had not been willing to take him. They were however able to get him temporary medicaid and after 130 days in the hospital, he was finally moved to a nursing home. He was moved back to the hospital after 3 months when his status could not be confirmed. He lived on the third floor of the hospital for many more months until Immigration finally confirmed he was a legal permanent resident and he was finally moved back to a nursing home.

He is still very far away from his family and birth place. In his almost two years stay in the hospital, he has had no visitors, and does not appear to have any close friends.

I wonder how he must feel, unable to speak and also not understand anything said to him while in a place that is so far from his home.

It is however amazing to see the dedication and hard work from his team of doctors, podiatrists, nurses, physician assistants, social workers and others. They have taken great care of this man, selflessly and with tremendous dedication. This makes my faith in humanity stronger than ever before. I hope and pray that our patient is in a place that will provide him equal care and comfort.

Gye Nyame - a symbol of the Akan people of Ghana

Frank

Frank

Recently we were in the process of moving from one home to another. I was going through a file of old papers, when an envelope fell out and caught my eye. It was addressed to me in such neat handwriting that it appeared printed. It was dated May 1st, 1998. I saw the return address was a Nursing Home. The name on the address instantly took me back to a very memorable patient of mine. His name was Frank. This is his story.

I first met Frank in 1996, when I was a second-year resident in Internal Medicine. I was asked to start seeing a patient who was described as being difficult and had fired two other residents from taking care of him. I did not want to have the same result, so I thought I would try to find out why he was so unhappy with his care.

Frank was a thin and short man. He had a closely cropped hair cut and looked really neat and clean. He had been admitted with an exacerbation of emphysema which caused breathing difficulties. This was mostly from a long history of smoking. He had never married or had any children. His only brother had died several years ago. I asked him why he was so unhappy with his care.

His main concern was that he liked to follow a schedule in everything. His food should be at a particular time as should his medications and breathing treatments. He even was very concerned about being able to go to the bathroom at least once a day, and he had been constipated since being admitted to the hospital. In his opinion the previous physicians had not taken these concerns seriously.

All my life I have been around family that have obsessive compulsive traits, and I realized that Frank was probably somewhat obsessive compulsive and felt the need to have more control in his life. I talked to his nurses and got him on a more rigid schedule. I even put him on laxatives and his bowels became regulated.

He did not fire me. On the contrary when he was ready to be discharged, he became my clinic patient and started to follow me as an outpatient. We became great friends. He told me stories of his career as a fireman and even shared pictures of his younger days with me. I realized then that he did not have any close family or any real friends. This may have been partly due to his obsessive compulsive personality.

Unfortunately, his emphysema continued to progress and he could no longer live on his own. We spoke at length about this and decided that a Nursing Home may be the best option. He was naturally sad about this. I would also no longer be his doctor as the nursing homes have their own doctors. We said our good byes and he was emotional, as I was. I did not know if I would ever see him again.

It was Christmas 1997, and I was pondering on my list for sending out cards. For some reason I thought of Frank and I mailed him a card to his nursing home. I was later informed that he had moved to another nursing home and was not sure if he ever got that card.

Several months later I received a letter in the mail. It was from Frank. In that letter he mentioned being pleased on receiving my card, and also described (with his meticulous handwriting), of all the problems he had in the nursing homes. He was moved from one to the other all over Eastern North Carolina. He was finally at a place he liked. In that letter he said very nice things about me, and this touched me greatly.

I later looked up the address of his nursing home, and realized that his small town was coincidentally very close to the small town I was going to be starting a new job in.

Soon after I started my new job, I did go to visit him on a Saturday afternoon. It was a typical nursing home. Quiet, dark and with a musty smell. The nurse on duty was surprised that Frank had a visitor. She led me to his room, and there he was, in a wheelchair with an Oxygen canula attached to his nose.

He was surprised, and appeared very pleased. He hugged me and we sat and talked for a while. He told me that he was quite content at this current nursing home as things were done as he liked. I promised I would visit him again.

However, soon after my visit, Frank passed away. He died peacefully in his sleep. I have kept his letter all these years and hope and pray that he remains at peace.

Excerpts from Frank's letter

Honey and Placentas

Honey and Placentas

I was reading a recent article about how a type of honey called Manuka honey from New Zealand has been found to have antibacterial properties. It is not necessarily effective as an antibiotic when eaten, but more so when applied locally over wounds. As a dressing it was found to be more effective at healing wounds than some of the more expensive dressing materials.


This took me back to my medical school days in the town of Zaria in Northern Nigeria. It was thirty years ago, and I was doing a General Surgery rotation. Our Senior Registrar was Dr. Vincent Odigie. A handsome young man, he was bold and assertive and always supremely confident. He was also very smart and often did things in an unconventional way.


One day we were seeing an elderly man with an infected diabetic foot ulcer. Conventional treatment with antibiotics and traditional dressings had not helped for several months. Dr. Odigie said we need honey. We students were incredulous. Honey? Yes, honey he said. He told us that traditional honey had natural antibacterial properties and bacteria could not utilize honey for food. I still remember him telling us that only bees, humans and bears could use honey for nutrition.


He asked the patient’s son to go and get some traditional honey from the local market. The store bought honey is not as effective he told us as it has additives. The patient’s son soon came back with a jar of local honey. It did not look too clean and we students were not very optimistic. Dr. Odigie laughed and assured us this will be sterile.


He unwrapped the wound and covered it with honey and wrapped it up. He then told the students that the wound will not be inspected for seven days. We were incredulous. However seven days later when we inspected the wound. All the infection was gone and it was just healthy granulation tissue ready for a skin graft. All of us students were thoroughly impressed.


On another day, we had a young lady who had sustained significant burns. The burns were not deep but she was in considerable pain. Dr. Odigie looked at her and said we need some placental lining. Even though we students were used to his unconventional approach, we were very confused. The lining of a human placenta he explained is very effective in treating these kinds of relatively superficial burns. He taught us that a dressing made of the placental lining of a human embryo helps ease pain and promotes healing of the skin.


Where are we going to get this placental lining one student asked? The labor and delivery ward he said. It was late in the evening, but Dr. Odigie was a very dedicated physician. He marched the students to the labor and delivery ward and asked the rather surprised charge nurse there if she had a discarded placenta we could have. The nurse was used to Dr. Odigie and did not bat an eyelid. She said the Gynecologists were just doing a C-section and she would get us that placenta instead of discarding it. Dr. Odigie beamed a smile.


She soon brought out a placenta for us. Dr. Odigie then proceeded to cut out the placental linings. He then rigorously washed the tissue and then put it in a disinfectant and proceeded to the burn patient. The sun had set and we students were tired, but we had to see this.


The young lady was in considerable pain. Dr. Odigie carefully undressed her wounds and then proceeded to place the placental lining tissue over the wounds. He then wrapped the wounds with a regular dressing. Once he was done, our patient did look more comfortable.


Our patient did quite well and within a week her wounds had healed enough for her to be discharged. I saw a recent study done that showed placental dressings reduce pain and allow for faster healing.


We students learnt a lot from Dr. Odigie. He may not remember me or these lessons he taught us, but I will never forget them. Today he is Professor Vincent Odigie of Surgery at my old teaching hospital.

Sometimes unconventional approaches can be very effective and just imagine my delight to see all this talk of using honey for wounds today in the more developed countries. I can say confidently that this approach is effective as I have seen this myself thirty years ago!

Manuka Honey

The American Indians

The American Indians

Today I read about the untimely death of Indian actor Tom Alter at age 67. He had died of skin cancer. He likely developed this skin cancer in part due to the abundant sun exposure in India. You see, he was a fair skinned Caucasian.

Mr. Alter was the grandson of a missionary who had come to British India in 1916 from Ohio in the United States. Mr. Alter's grandfather had a son who was born in the city of Sialkot which is in present day Pakistan. When the Indian sub- continent was partitioned in 1947, the elder Alter remained in what is now Pakistan, but his son (Tom's father) had become a missionary in the city of Mussorie in India.

The partition of the Indian sub-continent by the British split many families including those of my parents. I however never imagined that it also would affect an American family living in India.

Mr. Tom Alter was born to his missionary father in Mussorie in India in 1950. His grandfather remained a missionary in Pakistan, and the young Tom Alter grew up in the Indian state of Uttar Pardesh. He was fluent in Hindi and Urdu. When it was time to go to college, he was sent to Yale university in the United States.

He however did not like Yale, and left after a year and came back to India. After trying a few different things, he fell in love with an Indian movie starring the Indian super hero of those days, Rajesh Khanna and decided to become a movie actor.

I can imagine that it must have been difficult for a Caucasian man to make it into Indian movies in the 1970’s, but Tom Alter did. Some of his roles portrayed him as a British man speaking poor and broken Hindi. Interestingly he himself was very fluent in both Hindi and Urdu, and even well versed in Urdu poetry.

He did succeed and eventually worked in over 300 movies including a movie with his idol Rajesh Khanna. Also, incongruously for a man of American origins, he became a great fan of the game of cricket and even became a correspondent for a cricketing news organization. He was eventually given the fourth highest civilian national award of India, the Padma Shri and was much loved in India. He once said in an interview that he hates being called an ‘angrez’ (white man). He said he was Hindustani (Indian) and proud of it.

In this day and age, it is more common to see immigrants to the United States rather than the other way around. I myself am an immigrant. While growing up in Nigeria, two of my closest friends were American brothers. Their father had moved to West Africa in the 1960's, but it is generally rare to see an American who has made another country home. However, recently I met another.

I work as a doctor in a small town in North Carolina. On one recent day in the clinic, a man in his late sixties came in as a new patient. He had just moved to our small town to live close to one of his daughters who lives here.

As part of my history, I asked what he did for a living? He had been a teacher, he told me and he had just retired. Where did you teach I ask? ‘India’, he replies. I was taken aback. You mean the country of India? Yes indeed, he replied.

This made me very interested and I asked him for more details. He told me that as a young couple both him and his wife had been interested in missionary work. They left America in the 1980’s and first lived in North Africa for a few years. Their first child was born there. They then moved to India. They moved between different cities in India. Their second child was born in the Indian city of Patna.

I found this very interesting as my parents were originally from the Patna area of North Eastern India. He lived with his family in India for 28 years. His daughters grew up there. He came back to America to take care of his elderly father. The family was initially split as his wife tried to stay on in India with his children.

After four years, his wife also moved back. One daughter had gotten married and moved to my small town. My patient moved here after his father died. He found a job here and became my patient. Both him and his wife are some of the most humble and nicest people I have ever met.

When I decided to write this essay, I titled it ‘The American Indians’, even though this has nothing to do with Native Americans who are also called by that name. I think it is the people above who more accurately fit this title

Tom Alter

Sabo

Sabo

This is a memorial for my dear friend Sabo Saleh who died a few years ago. Sabo Saleh was my classmate in medical school and we also started out residency together. We had many memorable times with each other. Here is one incident that I remember distinctly.

Sabo was the son of a farmer from a small village in Bauchi State in Northern Nigeria. His family was of modest means and most people in his village became farmers. Sabo was different. He excelled in his elementary school and got a scholarship to secondary school. Over there, he excelled again and was eventually admitted to medical school at the Ahmadu Bello University in Zaria, Northern Nigeria. I was his classmate.

Sabo was muscular, stocky and a picture of strength. He was characteristically bold and feared no one. He never hesitated to speak his mind and could be quite blunt. This attitude would sometimes get him into trouble, but he was much liked by his classmates. We all respected his fearless attitude and we knew that he had a great heart underneath that gruff exterior.  

After graduation and an internship year, Sabo eventually started a residency in General Surgery. By that time, I had started a residency in Orthopedics. We would meet often in the hospital.

One particular day in early 1993, we were both working in Operation Theater two. I was with the Orthopedics team and Sabo was with the General Surgery team. The other resident in Surgery was our mutual friend Ahmed. Like Sabo, he was also from Bauchi state. On that day, for some reason, Sabo was mercilessly teasing and taunting him in his characteristic style. However, it was all in good fun and all of us were laughing.

I went in for a case, and then when I came out, Sabo was scrubbed in another Surgery case. In the physicians lounge I come across Ahmed. He was sneaking out Sabo’s clothes from the changing room. What are you doing I asked? He put a finger to his lips and said to me, “Quiet, I am getting back at Sabo, don’t say anything”. He explained that he was only going to hide the clothes for a little bit as a prank.

It appeared a harmless prank, and I thought nothing of it. I went back in for another case. When I got out, there was pandemonium in the physician’s lounge. Sabo had come out and noticed his missing clothes. He became upset as his home keys were in his pockets and he thought somebody might use them to break into his house. He got another resident to drive him home immediately while still in scrubs. The theater staff was busy trying to find the missing clothes and keys.

I ran back in and grabbed Ahmed who was just coming out of another case and told him. A look of fear came over Ahmed. He looks at me and says Sabo will kill us. Us, I say? Why us? I have nothing to do with this I protested! You knew about it he replied, that makes you an accomplice. Now take me to him so I can return his stuff to him. Ahmed later told me that he wanted me along as he thought Sabo will then go easier on us, since he was my good friend.

So, we changed and I drove Ahmed to Sabo’s apartment. Sabo was standing outside his locked door, not looking happy. We ran up to him, both pleading for forgiveness even though I was not sure what I was apologizing for. A surprising thing then happened. Sabo started laughing. I think he saw the fear on our faces and found it very funny. In the end, there were no hard feelings.

Some months later I was leaving for America and both Ahmed and Sabo were at my farewell reception. The very macho Sabo had tears in his eyes as he hugged me and bade me farewell. I never realized at that time that it would be the last time I ever saw him.

A few years ago, Sabo was diagnosed with cancer. This cancer took the life of my strong and tough friend leaving behind a wife and three small children. I will never forget the fun times with him and pray that his soul rests in perfect peace.

As students with Sabo in 1989

With Ahmed in 1993

In Operating theater two in 1992

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.