We see farther because we stand on the shoulders of giants.’ I remember this quote from decades ago (when I was in first year of medical school), as it was written in my ‘hand me down’ anatomy textbook: ‘Keith Moore’ as we called it.
I never really understood what it meant then. All I knew was that someone, who had used the book before me, just loved it enough to write it there.
But a couple of years ago, as I did my first peritoneal dialysis (PD) in a district hospital in the middle of the night, I understood the meaning of the quote. For that night, I stood on the shoulders of giants.
A kid, Lawrence (not real name), had been brought in to our kids’ emergency unit. He was all swollen up and his blood pressure was terribly high. He was restless and was having difficulty in breathing as his lungs filled with fluid.
He wasn’t passing any urine and we knew it wasn’t a good sign. We quickly got his labs done and it confirmed our worst fears: his kidneys were failing. His heart was struggling too, as there was a buildup of toxic substances and fluid that his kidneys would have gotten rid of; if they were working well.
He needed dialysis. But we were in a district hospital four hours away from the nearest place where he could get dialysis done.
He was so unstable for referral too and so we were between the devil and the deep blue sea.
First peritoneal experience
I had seen peritoneal dialysis done before but I had never done it myself.
A training programme had been organised in one of the big hospitals where we were taught the theory and practice of PD using simulation. A couple of months after that I was fortunate to observe it done on a real patient. I remember that day clearly.
One pediatrician had died and I was with friends at his funeral. The casket had just been closed and the pastor was preaching. Then we got a call from Prof. Antwi, our paediatric nephrologist, saying if we wanted to observe a PD we should come immediately to the hospital!!!!
We were at a funeral for goodness sake. I am an Ashanti. We love funerals. We had intended going to the cemetery, wailing as we shed some more tears and marked the final resting place of our colleague. After that we would go for the family gathering as well. But no. Prof. Antwi said we needed to come immediately.
Prof. is one of those lecturers who teaches his students all he knows. He doesn’t take pride in being the only person in the country who can do a particular procedure like some folks do. Ever since he came back from his nephrology training he has been saving the lives of kids with kidney problems.
We would have such great fun in his classes as he was a great and interesting teacher too. You could never fall asleep in his teaching session. Very down to earth and easily approachable.
But back to our funeral story.
So we trooped to the ward still clad in black with red rimmed eyes. And Prof. taught us how to do the peritoneal dialysis on a real patient.
But you know it’s different watching it done with a boss compared to doing it on your own in the dead of the night, four hours from any help.
Cards on table
I called the mum of Lawrence to my consulting room and laid the grim options before her. He could go on referral but there was no ambulance (and she didn’t have money) and the kid was not stable and could die on the journey.
Or we could do it here. But I hadn’t done it before. And she placed the burden back on my shoulders. She told me to do whatever I thought was best!
So I let the team start preparing the items for the procedure.
I sat in the consulting room praying and then I called Dr Sarfo. Everyone calls her Anima and she never fails to help you sort out a kid with a kidney problem (she has no idea the number of chickens and eggs I have received from patients following the help she gave me for them).
TO BE CONTINUED…
