Chapter 2: Hospital Palava and Hidden Roots

Na there I first meet this patient.

Hospital smell—mixture of Dettol, sweat, and small jollof rice from nurse lunch bag—full everywhere. The moment I see her, I sabi say this case go long. The man kneel small, beg me with two hands: “Doctor, abeg, help my wife.”

My first impression—she resemble person wey don craze.

Her mouth dey move, but words no dey clear. She just dey look everybody as if she no dey see us.

Her hair scatter, face blank, eyes no get life.

If you see the woman, you go know say this na serious matter. Even the hospital security look her twice before allow am enter.

For emergency, you dey see all kinds of people, but this na my first time see real schizophrenia.

Na true talk, because some cases na fake or small-small madness, but this one heavy.

That time, I no get experience with this kind sickness, so inside my mind, I dey complain.

I dey reason say, 'Which kind wahala be this for midnight?' I even dey pray make the night pass quick.

To admit this kind patient for midnight—na wahala be that!

Nurses dey look me like say na me go do everything. Everybody dey eye clock, but duty na duty.

But as I see her husband red eye, all my complaints just disappear.

The man face tell story—tears no even gree fall, e just red. I gree say this na real wahala.

I know say the person wey dey suffer pass na the tired, old-looking husband wey stand for my front.

His shoe dusty, shirt never iron. The man no fit even talk well, voice dey shake.

He don already pass through plenty things, and he tell me everything.

I just keep quiet, dey listen well, dey nod. For Naija, sometimes na listening be the best medicine for family.

I call nurses, together we carry the patient enter emergency room, connect her to cardiac monitor, put BP cuff, check her blood pressure—

The nurse dey use soft voice talk to Madam Ronke, 'Mummy, abeg, give me your hand.' But she just dey look. At last, we connect all the wire.

After all this, the patient just dey calm, no make noise, which surprise me.

Even her breathing slow. The nurses begin whisper, dey look me like, 'Oga, are you sure?'

I think say she go scatter the emergency room, so I don already tell nurses to ready sedatives like diazepam and haloperidol, to use IV if she start misbehaving.

I already collect consent from her husband in case we need tie her hand or give injection, because you no fit predict.

Her husband say na for house she dey craze, but once she reach hospital, she calm down.

I even laugh small. E dey happen—some people na only for house dem dey act up. Maybe na hospital fear or angel dey present.

As I read her medical records, hear all the symptoms, and see the cranial scan, the schizophrenia diagnosis make sense.

For book, all the symptoms line up. I dey tick am one by one for my mind.

But my mind still no rest. Something just dey off. I feel say her case fit be more than just schizophrenia—maybe na my instinct.

My spirit dey warn me say, “No be only the eye wey dey see problem—sometimes na the one wey dey hide dey dangerous.”

Na so sometimes doctor spirit dey warn am. For Naija, we dey call am 'third eye.'

Or maybe na normal alertness.

But I know say for night duty, you gats double-check everything. Sometimes, wahala dey hide inside another wahala.

If emergency doctor no get small sense of suspicion, e for don die since.

My lecturer for school dey always shout: 'Never trust diagnosis wey you no check yourself.'

Schizophrenia no dey kill person, but if na another sickness for body cause am, e fit turn fatal any time.

For my mind, I dey calculate which one fit kill quick. God forbid, if I miss am, na story.

For example, hepatic encephalopathy, uremic encephalopathy, and so on.

If liver or kidney wahala dey, person fit dey behave like mad person—Naija hospitals dey see am steady.

I explain all this to her husband.

I tell am say, 'Oga, mental wahala fit come from body sickness. Make we check everything, so we no go miss anything.'

Anyway, first step na to put her for emergency room, hook her to cardiac monitor.

Even her husband help arrange the pillow. The nurses dey move well, put drip, check everything.

Then I tell the resident doctor to call neurologist for review. We suppose call psychiatrist, but none dey on duty for night, so neurology na the next option. Second opinion no dey bad.

For Nigeria, specialist no too plenty, so sometimes you manage who dey available. The resident quick call.

Her BP come out: 210/100 mmHg!

Everybody look the machine twice. Even the nurse say, 'Oga, e be like error.' I say, 'Check am again.' Same result.

Ah! This BP na wahala—God forbid make e turn to stroke.

Everybody just dey pray inside mind, 'God abeg o.'

That one join my worry.

I dey remember one case wey BP high, before we know, patient collapse. I no wan make that kind story repeat.

The patient never get hypertension before, but this kind BP no normal at all.

I even ask her husband, 'She dey take any medicine before?' He say, 'No.'

If she dey agitated, maybe tension and anxiety cause am. But now she calm, so this BP na serious matter.

Nurse dey check her pulse, I dey monitor her breathing, just dey hope make e no turn emergency within emergency.

Plus, the woman fat small, round face—na the type wey dey get “three highs” (hypertension, high cholesterol, high sugar), so I need shine my eye.

Her cheeks round, skin dey glow small, but I dey reason say fat for our people sometimes dey hide wahala.

I dey fear make e no be stroke or brain bleed, so I check her limb strength. Nothing major, but her grip weak—when I say make she shake my hand, e no strong.

I say, 'Madam, grip my hand.' She just touch am small, no force. I dey reason say e fit mean different things.

Maybe na hunger—her husband talk say she never chop well for days.

The man dey explain, 'She never chop, she never drink water.' E pain am.

I just nod, no talk anything sure.

For my mind, I dey list all the things wey fit cause am. Sometimes, na hunger dey do pass malaria.

Family no go know, but my mind dey run different things.

Doctors dey fear to talk sometimes, because if you talk am finish and e no be that one, family go say you no sabi.

Plenty sickness dey cause mental symptoms. For emergency, the common ones na uremic encephalopathy, hepatic encephalopathy, and pulmonary encephalopathy. We need run blood test quick—liver function, kidney function, blood gas—everything go clear.

I write all the tests, give nurse, make dem rush go lab. Time dey run.

Plus, cranial CT dey necessary, because her case don worse, BP high, and muscle strength low. If CT clear, my mind go rest.

Even though e cost, I tell the family say na important. Health pass money.

I tell her husband: even though dem do am before, this time different. Make we repeat am for peace of mind.

The man no even argue. He just dey beg, 'Doctor, abeg, do anything.'

Her husband no waste time, say he go do anything I talk.

I see the fear for his eyes, so I just tell am make e try relax. He nod head, go find money for reception.

I like family wey dey cooperate—e make work easy, no stress.

Some people go dey argue, dey ask too much question, but this man just gree.

Soon, nurse check her temperature—moderate fever.

I look thermometer twice. Fever join—wahala dey increase.

That one strange—fever mean infection, but where?

For person wey no dey move, infection fit hide anywhere—urine, chest, even skin.

Most times, na chest infection, so I listen to her lungs.

I put stethoscope for her back, hear the sound. E be like small water dey boil for there.

I hear some moist rales for left lung. As we don talk before, moist rales mean water dey enter airway, the sound na from air dey burst the bubbles.

I call nurse, make she hear am too. For hospital, na so we dey learn from each other.

I check her breathing—fast small.

Her chest dey rise and fall sharp. I dey count am for my mind.

She dey cough or spit? I ask her husband.

The man say, 'No cough, no spit, just dey weak.'

No, he say he never see am cough or spit. Only say she no dey eat.

He shake head, say, 'She just dey sleep, no dey talk.'

But I no fit rule out pneumonia. Pneumonia fit cause fever, rales, fast breathing, and even make mental wahala worse. I explain this to her husband.

I say, 'Oga, infection for chest fit make brain dey behave anyhow.' He just dey nod, dey look me with hope.

Truth be say, I no too get experience for psychiatry, but logic tell me say infection like pneumonia fit worsen schizophrenia.

As doctor, even if you no be expert, common sense na your friend. I gree say infection dey spoil mental wahala.

I say make we do both cranial and chest CT.

I write the request for both, make e no be say we miss anything. For Naija, scan dey expensive, but family gree.

The family agree sharp sharp.

The husband just say, 'Doctor, abeg, anything.' He dey sweat for hand as he sign consent paper.

Before CT, I tell nurse to draw blood for routine test, then we push the patient go CT room.

Nurse dey gentle, dey talk to Madam Ronke, 'Mummy, e go quick.' Her husband dey follow, dey pray.

As we dey go, we hold sedatives ready, in case she start misbehaving—just give injection, I tell nurse.

I remind nurse to keep eye on her, because sometimes, patient fit change mood any time.

CT go well.

No wahala. Technician dey sharp. We fit see the images immediately. The head dey okay—no bleeding, no tumor.

Everybody sigh. At least, brain dey intact.

But for lungs, wahala dey—some inflammation for left lung, which fit explain the fever, rales, and fast breathing.

I dey point am for computer screen, show husband the area. He just dey nod, even though I no sure if he understand.

I tell the family: the woman get pneumonia.

I say, 'Na infection for chest. We go treat am, e go better.' Family relief small.

But e no too serious.

I talk say, 'No be that kind wey go kill, but we no go relax.'

But as she come back to emergency room, she suddenly get seizure—e shock me.

I see her body shake, eye roll, hand stiff. Nurse shout, 'Doctor!' I jump up.

She just grip teeth, hands dey shake, face show fear, like say she see masquerade.

For Naija, if pikin see masquerade, e dey run. Her face show say e dey see something we no fit see.

For night, if this happen for house, her family go run.

Her aunty shout, “Jesu! Cover us with your blood!”

Even her sister begin pray loud: 'Holy Ghost fire!' For emergency, we no dey fear, we just dey act.

I calm down. As I wan tell nurse to give medicine, the seizure stop by itself—last less than five seconds.

Nurse hold injection, I say, 'Wait small.' Before we blink, seizure end.

E come and go just like that.

I look clock, e no even reach five seconds. Everybody just dey breathe.

After the seizure, she weak pass before.

She just collapse, body limp. Nurse help arrange her head well for pillow.

She lie down for bed, dey struggle to breathe.

I dey watch oxygen level, dey monitor her well. Her breathing dey heavy.

Thank God her vital signs still dey okay, my mind rest small.

I say, 'Thank God.' Her BP still high, but she dey stable.

The neurologist come, check the head scan, do small neuro exam, say e no look like stroke or brain bleed, but still advise make we do MRI.

Oga neurologist bring big book, dey explain to resident. Me sef dey listen, dey learn.

MRI and CT different—MRI fit see things CT no dey see, like small stroke or tumor.

Na true, for Nigeria, MRI dey show pass CT, but e cost die.

But the family say she do MRI before, e show nothing.

Husband dey argue small, but I say make dem reason am.

Neurologist pause, then say: condition fit change—no problem before no mean no problem now.

He say, 'Oga, make una gree. Sometimes problem dey hide, fit show later.'

Exactly. As I tell the family, this time different.

Dem gree. I write another request.

For safety, better do MRI to rule out stroke or other brain wahala.

For hospital, we dey say, 'Better safe than sorry.' Family thank us.

Since no neuro problem for now, she go stay emergency, psychiatry go see her next day.

For night, no psychiatry, so we dey wait till morning. Nurse arrange her drip, adjust blanket.

Now, resident doctor come report say blood test result don come—nothing much, but potassium extremely low, only 1.8 mmol/L (normal na 3.5–5.5).

As resident dey talk, I dey reason say, 'Wetin? 1.8?' Even nurse open mouth.

I expect am—1.8 na very serious hypokalemia.

1.8? E low pass NEPA light for rainy season.

Wetin cause am? I ask resident.

I dey look resident face, make e reason well.

Probably because she never chop, resident answer by the book.

I nod. Hunger dey cause wahala pass wetin people dey think.

That one make sense for now. Family say she never dey eat.

The man even say, 'She no dey drink water.'

Resident analysis correct, at least for now. We give her potassium chloride.

Nurse run go pharmacy, mix the thing, put for drip. We dey monitor am sharp.

We need raise her potassium quick—1.8 too low, she fit collapse any moment.

I dey pray say her heart no go fail for my shift.

Potassium and sodium dey important for heart. If potassium too high or low, heart go misbehave.

Even small pikin for med school sabi that one. Heart na king for body.

Serious hypokalemia fit kill person. Just some months ago, news talk about patient wey die after surgery—autopsy show severe hypokalemia.

For ward, dem dey gist about am. Everybody dey fear make e no happen for their hand.

I tell resident the danger—these na lessons written with blood.

I dey always talk say, 'If you no know, ask. If you see strange thing, shout.'

Plus, the seizure fit relate to hypokalemia—quickly correct am.

As I dey talk, nurse dey pump potassium, dey check drip.

Since she enter, we never do ECG—must do am, I tell resident.

I dey reason say, 'If heart wahala start now, na ECG go save us.'

With this low potassium, ECG important; resident fit even learn the ECG signs of hypokalemia.

I dey use chance teach resident, because tomorrow, e fit face same thing alone.

Resident happy, rush go bring ECG machine.

He dey shine teeth, dey say, 'Oga, make I do am sharp.'

To connect ECG, you need roll up the patient leg. As resident do am, something catch my eye.

I dey watch closely, because Naija patient fit surprise you any time. Make I see wetin go happen next.

As he roll up her leg, resident frown, wan talk, but hold back, then look me.

I notice the way resident dey squeeze face, but e no want talk too loud. Na so I begin dey watch am well.

I dey watch from side, I see everything.

I adjust my glasses, heart dey beat. Wetin I see for Madam Ronke leg fit change everything. Story never finish.