By Emmanuel Fashakin, MD, Esq.
Sir Robert Hutchinson, who was President of the Royal College of Physicians alluded, over half a century ago, to the ghosts of dead patients chasing Doctors about in the midnight hour. We will talk about “ghosts” today.
My “ghost” walked into the surgical out-patient of the Obafemi Awolowo university Teaching Hospitals Complex one wet day in June 1988, a few months after I was appointed Lecturer/Consultant Surgeon in the University. He was emaciated and malnourished. According to his wife, he had been unable to eat properly for several months, and vomited quite often. There was suggestion of a palpable mass in the upper abdomen as I examined him.
The initial clinical impression was that of upper Gastrointestinal malignancy, possibly cancer of the stomach. However, barium studies soon showed that he had chronic duodenal ulcer with severe obstruction in the gastroduodenal area. He was salvageable, and with surgery, he should have survived.
He was prepared for surgery, which I approached with a lot of enthusiasm, being my first case for gastrectomy and gastrojejunostomy since I was appointed Consultant Surgeon. To the layman reading this, this man had obstruction in the junction of his stomach into the intestine, and the corrective operation was to cut off the lower half of the stomach and join the upper half to the small intestine. The patient was prepared for surgery.
The surgery went very well, and there were virtually no technical challenges. After I was reassured two different times that all instruments, swabs and towels were complete and all accounted for, I closed up the patient. Because the patient was from far away place in Ekiti, he was kept in hospital until the sutures were removed. By the end of the week, the patient was able to eat pounded yam for the first time in months. The wife and patient were very grateful as they left for their town about ten days after surgery.
Five months after surgery, I was in the outpatient when our patient walked in with his wife. His abdomen was protuberant and he appeared ill. What happened? He said that he had discomfort in the abdomen and had not been feeling well. I examined his abdomen: it felt doughy and tender. X-rays soon confirmed every surgeon’s nightmare: there was a large piece of towel in the lower abdomen!
Then it all came to me. As I was joining the stomach to the jejunum, the coils of small intestines kept sliding into my view, and I asked for an extra piece of green towel to wrap them. In the rowdiness of the operating theater, the circulating nurse forgot to record the extra piece of fabric supplied to me. Somehow, the towel slid between the coils of bowel and ended up in the abdomen. When I asked for the first and second counts of swabs and towels, I was reassured that all was correct because the extra towel was never recorded on the board.
As soon as I opened up the patient, I knew that he was doomed, because the bowels were perforated in not less than twenty places after the towel was removed. I resected the more damaged portions of intestines, and repaired the rest of the holes. But the bowels were so edematous and shredded, that I knew that the chance of survival was minimal, especially because we had no intravenous nutrition to keep the patient alive while the bowels heal. We returned him to the surgical ward, with prayers that he would somehow pull through. But his condition worsened in the days after surgery.
As his left ebbed away, his wife kept vigil at his side. She did not leave the bedside to clean up, and had nothing to eat for two days. As I arrived at work on the patient’s last day, I told the wife to go and eat. The patient opened his eyes briefly and joined me in urging the wife to go and eat: “l’a jeun!” (Go and eat!), he commanded. They proved to be his last words as he soon slid into the final coma. I have heard those words “l’a jeun” echo in my head all these years. I look back on the case. The atmosphere in the operating room that day was unprofessional, and if I was a more senior surgeon, I would have been able to correct the nurses who were just chatting away. And if the patient had been seen in the days or weeks after discharge, we could have avoided a total catastrophe. “L’a jeun”!
The ghost of dead patients!
Emmanuel O. Fashakin, M.D.,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
