Setting: Branch of the St. Francis Hospital
Position: Private general practitioner
The waiting room is packed and I am busy with a patient when I hear a commotion and screams getting closer and closer. In a matter of seconds, someone knocks at my door, opens it and shows me a man covered with blood among a group of accompanying people. I ask my patient to return to the waiting room while I attend to this obvious emergency.
I usher in only the wounded man and his wife. He is a Muslim, and his originally white djellaba is now 90 percent red. I remove it and examine his skin, finding four stab wounds that he sustained from a robber in front of his bank. The worst is the section of the left subclavian vein. I suture the pectoral muscle with my thickest catgut, check his blood pressure and take him to the St. Francis Hospital myself because no ambulance is immediately available.
The cardiologist is not in the premises but he has been paged. After waiting for more than 30 minutes and with no information on his whereabouts, I decide to take my patient to the general hospital, which is not far away. Unfortunately, our convoy of three cars gets stuck in one of Lagos infamous “go slows” (the Nigerian term for traffic jams) and each time we stop, the patient’s wife jumps from her car to mine to check her husband’s condition. Ultimately, we reach our destination. No gurney is available. By chance, I spot a wheelchair in a corridor and grab it. A custodian witnesses the scene and is running after me as I wheel the patient toward the emergency department. There, people are lying on the floor and standing everywhere, some moaning, some crying, some praying.
I manage to locate the resident’s office, knock and walk in. First, I see his feet on the desk and then, through thick cigar smoke, his face. I bring the case to his attention and he says that first he needs to get a chest X-ray of the patient, then adds, “Please take a number and get in line!” I wait more than four hours, fearing the worst. Tired of waiting, the patient’s wife leaves. Finally, the result comes: There is no hemothorax or pneumothorax. At this point, I hope that things will speed up and that a vascular surgeon will take care of the wound. No such luck. The surgeon has gone to bed and the operation will have to wait until tomorrow. I go back home.
A few weeks later, the patient’s wife pays me a visit and gives me tokens of the family’s appreciation, including palm wine from her village. I inquire about her husband’s medical status. There has been no surgery. I later learn that he now goes to London once a year for a thorough cardiac assessment because he developed an arteriovenous fistula. He will not receive an operation until his heart begins to fail.
Lesson for the doctor: In many countries, physicians have a very different way of responding to life-threatening emergencies. Wherever you work, try to have a variety of contingency plans for dealing with such situations.
Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.