By Emmanuel Fashakin
Sandra was only twelve years old when her problems began. She noticed that she was getting tired easily, and could not run as fast as she could. Then one morning— a few weeks after the initial weakness— Sandra woke up and found out that her eyes and urine were turning yellow. She knew immediately that it was time to pay a visit to the family doctor.
The initial test results were extremely good. Sandra’s hepatitis profile screen showed that she was free from all forms of Hepatitis, A, B, and C, the viruses causing inflammation of the liver.
However, Sandra’s condition only got worse. The yellow coloration of her eyes, and now skin as well, only got worse, and it was time to get the specialists involved in her care. A liver biopsy was arranged, but when the results came, they devastated everyone: Sandra has Auto-immune Hepatitis!
An auto-immune disease is a situation where your own immune system starts producing immune agents to attack your own organs. For a crazy reason, your own immune system starts identifying your own organ as foreign tissue and attacks it.
Sandra was put on multiple medications to suppress the immune system, but things went only downhill. Within three years, Sandra needed a Liver Transplant, because her own immune system had completely destroyed her liver cells. After the Liver transplant, Sandra got better and was well enough to return to school. The whole family was relieved and happy. Unfortunately, after five years, the transplanted Liver started failing, because her body, which had attacked her own Liver, had started attacking the transplanted liver.
The transplanted liver was being rejected and that means only one thing: Sandra needed another Liver transplant!
The second Liver transplant took place six years after the first, and it was a huge success. With the advancement in transplantation surgery and the availability of better drugs to suppress rejection, Sandra did very well. Well, enough to earn her degree and meet a charming young man. They soon got married and had two children. Life could not be better. She continued to take her immuno-suppressive medications.
That was the situation when Sandra first walked into my office seven years before this story. Sandra was very beautiful and cheerful, and until she told her story, you would have no idea that she had gone through so much. By then it had been twenty years since her ordeal began, and the problem then was that she was having pains in her joints. She said she had been told that after twenty years of steroid therapy, needed to suppress her immune system, had worn out her joints. She was having severe pains in both knees and hips and was finding it difficult to walk. She came to me for medical clearance for an arthroscopy of the knees.
Arthroscopy of the knees and radiological studies of the joints confirmed that her knee and hip joints had worn out. A year after I first met Sandra, she had to undergo Total Hip Replacement on the Left side. The right hip was replaced two years later. In all these, Sandra was always cheerful whenever she came into the office. She was taking about twenty tablets every day, and I knew despite all the strong painkillers we were giving her, she was in great discomfort.
Sandra developed severe anxiety, which was understandable in the circumstances, and she responded to treatment with Xanax (Alprazolam). She continued to see me now and then for medical clearance for dental work and other treatments. Two years before this time, sixteen years after the second transplant, bad things started to happen again.
Sandra discovered that she had started feeling tired again, and then the slight tinge of yellowness of her skin. A visit to the Hepatologist confirmed her worst fears: her body had started rejecting her second transplanted liver which had served her well for sixteen years. Sandra came to see me afterward and told me the sad news — she is going to need another liver transplant — her third!
Even in her predicament, Sandra managed to give me a smile; I never heard Sandra say anything negative, or complain about her situation. Seven months after this sad visit, and that was about fifteen months before this story, Sandra came to the office to do blood tests and get referrals for Cardiology consultation in preparation for her impending transplant. Her jaundice (yellowness of eyes) had increased and she looked very pale. She tried to be cheerful, but you can see that she was in a lot of pain, and she appeared quite anxious. I tried to cheer her up as much as I could. I never knew that it was the last time I would ever see Sandra.
I did not hear anything from anybody for fifteen months thereafter (this is the major drawback of American medicine: lack of communication between the specialists and the primary care doctors, unlike in the UK). Sandra’s sister came to my Richmond Hill office to see me. I did not know that she had any relationship with Sandra until I asked her how she knew about me. She informed me that she was introduced to me by her sister, who was now dead. She said her sister told her that I am a good doctor. And who is your Sister? “Sandra xxxxxx”!
It was as if someone had hit me with a sledgehammer. Sandra! It was then I looked at her closely, she had a striking resemblance to Sandra, and she had retained her maiden name, the same as Sandra’s, who never changed it after her own marriage, as part of her married name. Everything became clear.
Through the Sister, I learned the rest of the story. Sandra was indeed admitted to the hospital after her last visit to me, and she was prepared for surgery. But Sandra went downhill and she was never well enough to have the transplant done. She died in the hospital after holding tenaciously to life for five more months. Her husband remained steadfast to the end and remained unmarried. He is caring for their two children with the help of his mother who lives with them.
I am very grateful for the opportunity to close the chapter on Sandra, a patient who suffered so much despite not doing anything wrong (she did not catch STD from sex, cancer from smoking, or liver disease from excessive drinking), but who taught me that you can have grace and dignity, even when going through extreme suffering.
I have treated tens of thousands of patients in my over forty years of medical professional life, but only a few patients make a very deep impression on you that you could not forget. Sandra was that type of patient. May her courageous soul Rest in Peace.
Emmanuel O. Fashakin, M.D., FMCS(Nig), FWACS, FRCS(Ed), FAAFP, Esq.
Attorney at Law & Medical Director,
Abbydek Family Medical Practice, P.C.
Web address: http://www.abbydek.com
Cell phone: +1-347-217-6175
“Primum non nocere”
