My houseman year began in the toughest unit in the hospital — paediatrics, neonatal ward, six months of continuous sleepless nights. I rotated straight into obstetrics and gynaecology without a single day in between. One month into that rotation, my body stopped tolerating what I was doing to it. This is the morning I will never forget.
I woke at 6.00 am, as usual, and felt a strange discomfort in my chest. My first thought was that I must have slept on the wrong side, and that with movement it would settle. I went into the bathroom and got ready for work — the morning review in the department was at 8.00 am, and I did not want to be late.
The whole way through the public transport I was wondering what was going on in my chest, and why every breath came with pain that did not respond to the depth I was taking it at. Each inhalation felt like a calibration. I was losing strength in my legs and I could not understand it. I told myself that once I reached the conference room and sat down, the strength would return.
I climbed up to the second floor and sat at the back of the conference room, not wanting to engage anyone in conversation, already tired before the day had begun. There was no position in the chair that was comfortable. The room had good ventilation, which was the only thing compensating for the fact that I could not inhale adequately. The review ran for an hour. I watched it the way a passenger watches a road.
At the end of the review, one of the senior consultants told me I would be assisting him on an endoscopic myomectomy that morning. I received the news with what should have been excitement — being handed such a procedure among one's colleagues and seniors is a privilege — and I think I masked it well enough that he did not see what was happening behind my eyes. I was still not fully aware of what was happening to my body.
The theatre
The endoscopic apparatus is kept in the theatre, in a tightly enclosed cabinet, and the theatre itself is significantly under-ventilated to protect against airborne contamination. The walk from the conference room to the theatre was, on its own, manageable. The moment I stepped through the theatre doors, the room collapsed on me.
My saturation began to fall. My heart rate climbed. I started sweating in the way that does not come from heat. The chest pain became severe, and radiated up to the clavicle and through to my back. My vision blurred. My feet stopped holding me. I fell into the shoulder of my colleague, Dr Garba, who caught me, lowered me down, and called for assistance.
I was taken to the VIP ward, as a member of staff. The senior registrar and a team of doctors came to take a history and examine me. It was the first time in my life that I had been the one on the bed, and the one being asked the questions, and the one for whom investigations were being requested. I have always loved my work. But seeing it from the other side gave me a different perspective, and shaped, positively and permanently, how I have practised since.
The round
I was supposed to be on the general ward round that morning, attended by the chairman of the Abuja Hospital Management Board — with whom I had a good relationship — and the senior consultants of every department. He had not been at the morning review, and when he asked after me on the round he was told what had happened. He led the team to my bedside. I became, briefly and embarrassingly, the celebrity patient of the hospital — every head of department instructed to attend to me kindly, internal medicine asked to ensure I recovered as quickly as possible.
The investigations came back through the day. ECG, ECHO, electrolytes and creatinine, abdominal ultrasound — radiologically, everything was normal. The blood film showed malaria parasites. The clinical picture, taken together, was a stress-induced exacerbation of an underlying gastritis, an opportunistic malaria on top of it, and generalised long-standing fatigue from six months in paediatrics without a break.
I was started on intravenous anti-malarials and intravenous omeprazole, converted to oral the following day, and discharged. The department gave me a month of rest before I resumed.
What I learned in that month
The limit of my body, which I had not previously believed had a limit. I had always thought, the way young men trained in demanding work do, that I could push myself to whatever level was required for the success I had decided I wanted. That morning told me otherwise. Since then I have paid attention — properly — to my routine exercise, to my diet, to my sleep, to the spacing of my work.
I tell this story now because most of the patients I look after in Abuja are doing what I was doing that morning. They are sitting in conference rooms at 8.00 am with a chest discomfort they have decided is nothing. They are walking from one meeting to the next on the strength of three hours of sleep and a paracetamol they took on the way out of the house. They are masking the symptoms long enough to finish the quarter. They are telling themselves what I told myself — that once I sit down for a moment, the strength will come back. It does, for a while. And then one morning it will not.
The lesson I took from that bed, and that I now carry to every patient I see, is that the body is good at suppressing signal until the signal cannot be suppressed any longer. At that point the choice you have is no longer about how much harder you can push. It is about what survives the collapse. The investigations save you. The doctor who knows you saves you. The month off saves you. The change of routine that you make afterwards is what determines whether you go back to the bed.
The good news, for the people I see now, is that you do not have to learn this the way I learned it. You can learn it from the side of the desk you are sitting on today.
— Dr. Paul Akinyemi