My first mortality...

We have been warned many times to never write about work on public internet spaces like facebook and blogs. That's why I stopped writing about my tales of Residency. But I realize, I am one who likes to share life with others... my experiences, my failures, even my embarassment. So I will write and try to maintain HIPAA in my tale. I write today about an event that happened over 6months ago but still haunts me. I write the tale of witnessing the last breath a particular human being, a child, took before he met his maker. I write to tell of how poorly we as medical people deal with death and dying. I write with hope that this event will continue to leave its mark on me. He was 10years old and fairly sick. He had other medical problems, part of which complicated his care. There was very little we could have done to save him. It happened so quickly. I remember the nurse telling me she was concerned about his heart rate. I remember he had fever at the same time. I remember when I went to check him he complained his stomach hurt and he was thirsty. His abdomen looked much bigger than it was when myself and my Senior had checked him 3 hours prior. His mother told us then he hadn't passed stool in a few days but she didn't want him to get any help, "let's give him one more day." So I focused on his belly pain and talked with the Senior about getting an xray to be show his piping looked ok. I had the senior come check his abdomen. And then he started to complain that he couldn't breathe but his oxygen saturation was fine and it sounded like he was moving air ok in his lungs. We decided to get a chest xray as well. Just as I was about to step out of the room and order the xray, he took a big gasp of air and then stopped. He stopped everything. We never got him back. There are so many questions I have asked myself over the las few months... Should we have started antibiotics at the first sign of fever? Should we have given him more fluids? Should he not have been on as much pain medicine as he was? Regardless, you can't stop a fat embolism from happening. You can only give supportive care when it does happen. And hope it is not massive enough to cause an abrupt decline in health status. His mother ok'ed the autopsy that confirmed cause of death. It gave us all a little respite. He will be remembered always. And because of him, I am even more diligent with the patients under my care.

Turning

Jesus, Jesus, how I trust you. How i've proved you o'er and o'er. 

Jesus, Jesus, precious Jesus. O! for grace to trust you more...

And as I live life on the daily, the command this year is 

2 Tim 2:15 

"Do your best to present yourself to God as one approved, 

a workman who does not need to be ashamed 

and who correctly handles the word of truth."

Another year to live for Christ. 

A year in which I desire to hear audibly from God regarding his plan for my future. 

After all, Iju ngu agula (It is God who determines)

Another year in which I desire to make my Father's heart smile. 

Ps 37:4 -  A promise by the One who does not fail...

To the glory of your name Baba

It is your name at stake

Tales of a First Year Resident: When it hits close to home

Today i realized my parent's mortality and it hit hard. It hit me that what is actually going into my dad's mouth has the propensity to kill him and save his life, and it all depends on an equation tested on rats and now performed on humans which trials have shown should go according to plan. Well what happens when one of the constituents of the equation lags? It hit me as i counseled my mother about what she needs for bone health, that outside of God's own intervention, she would have been wheelchair bound and maybe we would never be having this conversation...


It's easy when you are a doctor in training to be focused on getting work done rather than enjoying the moments at work; to be focused on giving information rather than ensuring information is received; to pay attention to the check list of things to send patients home with, rather than involve myself with the change in their life with what I have given. But here I am, dealing with the medical knowledge as it applies to the people I love, and the only defence I have is to doctor it up in other not to cry...


On thanksgiving day today, I am thankful for the reminder that life is fleeting. I am thankful for the blessing to sit in the same room with my parents after 3 yrs, even if it means I get to be their doctor and daughter all it once. And I am thankful that God intervenes and doesn't wait for us to thank him only for that which we remember. I am thankful for you Lord. 

Is God in this situation?

Remember the dark and distressing situation of Jesus on the night of his betrayal... 
Even Christ pleaded for the cup to be taken from him (Matt 26:39).
However, he knew that the hand which would for our redemption hold the cup to his lips 
was not the hand of Judas or Caiaphas or Pilate. 
It was the hand of His loving Father intent on redeeming us.


We learn the lesson of trust in the school of trial.

(adapted from Our Daily Bread 2009, March 20th)

He made it this far!!!

MI (Jude Abaga)

nominated for Best International Act at the BET Awards

http://betawards.bet.com/nominees/category/best-international-act 

Guess who is so not surprised? 

I knew he had it in him. 

And like I always tell him, 
this is just the beginning yo! 

Sorrow to Joy

"Weeping may endure for a night, but joy cometh in the morning." 

My bravest are those who can anticipate the morning and feel in the night of the sorrow 

that underlying Joy that tells of confident expectations of the morning. 

--God Calling 

by Two Listeners

Image from:

 http://static.photo.net/attachments/bboard/00O/00OnRD-42285984.jpg

I hurt...

Lord of all the earth 
And all of heaven 
I come and seek Your face 
Worship You with all I have within me 
Humbled by Your grace 

Every heart every nation 
Every tribe all creation 
Will bow before Your presence and sing 

You are high and lifted up 
You are high and lifted up 
And my soul sings hallelujah 
To the Lamb 
The Lamb of God 

Lord of righteousness 
You come in glory 
Bright and morning star 
All my days I’ll worship and adore You 
Healer of my heart 

Every prayer every cry 
You alone satisfy 
We will lift Your praise 
Again and again 

Majesty 
Majesty 
Jesus Lamb of God 
Majesty 
Majesty 
Holy are You Lord


High And Lifted Up Lyrics on http://www.lyricsmania.com/  
Image 1 from: http://www.theresurgence.com/Dodson_How_Should_We_Pray
Image 2 from: http://static.photo.net/attachments/bboard/00O/00OnRD-42285984.jpg

Tears in the RCU

Today I cried with a patient, actually, not with him, but for him, and maybe a little bit for myself also. 

72yo male with a history of stroke, high blood pressure, surgery on the left leg for broken tibia. He is an occasional drinker and a 63 pack year smoker. The patient was brought into the ER by ambulance after his wife called 911 because she found him on the floor and he could not tell her how he got there neither could he get up by himself. This was the second fall in three weeks. He was admitted for left sided pneumonia. Admission criteria (you need this to admit a patient for whatever disease and each disease has its own admission criteria) included 'confusion,' fever, age over 65 and shortness of breath. The fact that his chest xray showed what looked to be a picture of pneumonia helped to egg diagnosis in that direction. 

During his hospital stay we found that his 'left sided pneumonia' was not pneumonia at all. What had seemed to be 'confusion' on his admission was aphasia due to the stroke he had about 3 yrs back. Unfortunately ER staff could not tell because no one knew his baseline and his wife was not there when he was admitted so it was assumed that he was confused. When we got a hold of her the next day she was able to fill in a lot of blanks in his story. That got rid of one of the admission criteria for pneumonia. In addition, his fever of 100.4 as measured in the ER never resurfaced again so there went another pneumonia admission criteria. His shortness of breath did remain and he remained on oxygen via nasal canula. 


In the next few days and after receiving a complete history from his wife (history is so important), his diagnosis was changed to Chronic Obstructive Pulmonary Disease (COPD) exacerbation, and Congestive Heart Failure (CHF) exacerbation. Unfortunately the patient had also started showing signs of dementia which did not help with collecting information from him daily to assess how he was doing and because of his aphasia he was quite difficult to understand. Despite this, he and I established a good rapport; I learned to wait for him to get his sentences out and he learned to be patient with me and repeat himself several times until I finally figured out what he was trying to say. On my part, there was a lot of guess work in between. 

Three days into his admission he became unresponsive and was rushed to the MICU where he was intubated and received critical care management. I was distraught the day I heard. This was one week ago. 

This week he became alert and responsive and was moved to the Respiratory Care Unit (RCU) and back under the care of the team I was assigned to. When I saw him on Monday I was sad because this once somewhat healthy, rambunctious, "strong man" as he told me himself once, was reduced to tubes, and soft restraints to prevent him from pulling tubes out. Today I held his hand and looked in his eyes and saw how helpless he felt and felt helpless for him. I cried openly, apologizing to him for being such a baby but telling him I hope he gets well soon enough and I'll be praying for him. A few days after that his family agreed to move him to a nursing home as his wife was elderly and did not feel she could take care of him.  

My tears in the RCU reminded me that I have not yet become callous to the pain of others and compassion is a way of life, not a just a fleeting moment in the wind. 

Please keep him in your prayers. 

Excited, Uncomfortable and Sad

I am excited about four things: 

road trip this weekend

visit from dear friend

visit from former roommate and dear friend

the two friends visiting are going to Nigeria separately 

to two very different parts of the country 

(ok i'm also slightly jealous) 

Things that are making me uncomfortable this week:

money

my stomach

the political atmosphere in the US 

the fact that i cannot for the life of me wake up before 6am

And sadness for me comes in many forms. A few are:
people dying for the wrong cause

feeling that i am becoming complacent about people

not able to hug the living daylights out of my older sister 

because she's making me an auntie again 

being away from family
seeing a dead baby on the way to the mortuary

not being able to move beyond my fears and inadequacies... 

Not even half way through the week and yet so much... 

Thank God for the strength to make it through another day. 

New Year. Every Year.

As we begin another year, I feel I have found the perfect words that capture my heart's desire. Written by Roy Lessin of Meet Me In The Meadow 

Moving Ahead in God’s Will 

Lo, I come to do thy will, O God. Hebrews 10:9 KJV
 “Chance” and “luck” do not sit on the throne of heaven, but a loving, personal Creator does. Life is not a gamble and fate does not guide your destiny. God did not bring you into this world to live without a purpose, to exist without a reason, or function without meaning. He loves you, cares about you, and wants you to know Him and do His will.
He has chosen you and prepared you for the work He has called you to do. When your heart is set on His will, you will have the assurance that He will be to you all that you need. This confidence of faith allows you to move through each day with a peaceful spirit, inward rest, and quiet trust.
In the coming year, remember these five important things regarding God’s will for your life.
1. Place—Be in God’s place in His perfect time.
2. Peace—Let His peace keep you at rest in the place He has called you.
3. Purpose—Believe God’s purpose for you will be fulfilled in the place He has you.
4. Plan—Have confidence that nothing can frustrate God’s perfect plan for you.
5. Power—Receive His Spirit to equip and empower you to do what He has called you to do.

If we strive to remain in God's will there are many assurances the Bible gives 
one of which is echoed by the Apostle Paul

"I know whom I have believed

And am persuaded that He is able

To keep that which I've committed

Unto Him against that day." 
(2 Timothy 1:12, NIV)

Another assurance comes from Psalm 25:8-10, The Message
And it reads:

⁸ God is fair and just;
He corrects the misdirected,
Sends them in the right direction.
⁹ He gives the rejects his hand,
And leads them step-by-step.
10 From now on every road you travel
Will take you to
God.
Follow the Covenant signs;
Read the charted directions.

As God has determined
He will continue to if we let Him. 
The onus falls on you and I. 
I have decided to let him continue to determine
and to strive to abide in His will

What about you?  photo by Me