IV

  Ward Round

  I don’t remember what I was doing at that moment exactly. But I can tell you how I felt. Excited. Hopeful. Both. Like pressure building in a pipe, they continued to rise when Chisom said she didn’t know why Dr. Bernard was here. Dr. Ujah was the consultant around yesterday. And what she (Chisom) knows is that it’s the same consultant on duty on Saturday and Sunday. Usually.

  I could see Dr. Aliozor choosing this large-headed, short-mustachioed consultant who wears tight-fitting clothes (today he was on a polo shirt, black jean trousers, and sandals) a spring in his step, over the other two. For starters, he was the youngest, age-wise and on the professional ladder. In the limited time Dr. Aliozor had had, Dr. Bernard’s life would be the least complicated to assume. It wouldn’t have made much difference had I sent the names earlier, I said to myself, when an inner voice whispered I was partly caused the limited time.

  For a while, I was secure in my assumptions. I greeted him with my widest smile, flashing a knowing look his way, then staring fixedly at Ebuka, as he neared the doctor’s station. Again, searching for any sign… A smile in return, a frown, a nod of the head, a shake, a wave, a wink, even raising his eye-brows to show I was overdoing it.

  This reminds me of what I was busy with then. Dr. Ugo was showing Chisom and me how to nebulize the patient. She was on the bed directly across Ebuka’s. (The bed’s previous occupant had been relocated to a bed in the other arm of the ward.) I remember because Dr. Bernard was shooting straight for Dr. Ekumankah, who was seated at the side of the doctors’ station closest to Ebuka, and my greeting felt louder than normal.

  Dr. Chisom and Dr. Ugo followed my example.

  “Good afternoon,” he said in a reply that took in all of us, continuing on his way.

  I thought his voice sounded no different than it had on Wednesday last week, as he welcomed Dr. Ekumankah back to the CHER.

  “Thank you Chief. Happy to be back…” They went on to discuss briefly about her time in Newborn before she asked, “…Chief, if you’re ready…?”

  For what?

  “But you’re still documenting. Finish—”

  “Chief it’s just some examination findings and plan remaining. And since you’re here, perhaps you’ll want to adjust the plan…”

  “Ekumankah,” he said teasingly, chuckling. “Okay. I’ll be in the office. Let me know when you’re ready.”

  Did he glance at Ebuka? I asked myself, staring at his back as he turned around. And, concerning my assumptions… it seemed to me Dr. Bernard came for the ward round. I frowned at Chisom. All her attention was on the registrar. I needed clarity.

  I’d debate myself on the easiest path to that when Dr. Ekumankah asked Dr. Ugo if he had finished teaching us. She had a task for me. Gather the folders of all the patients; assemble forms, lab and prescription.

  Dr. Ekumankah had shown herself approachable. Hence, it was easy to conclude that she’d listen to my question, even if she didn’t answer it. But how did I frame it, directly or indirectly? This was the reason I put off questioning her until I was done with the task she’d set me.

  The best approach would be one where I got straightforward answers asking the least number of questions. “Chief, I thought Doctor Ujah is the consultant on call…” would get me more answers than “Chief, is Doctor Bernard leading the ward round today?” Though both lines of questioning would require I ask further questions. On the other hand, what if Dr. Ekumankah didn’t respond how I’d hoped? In a sense, I was basing what her responses might be on how I (a normal human being) would respond if in this scenario.

  Glancing at her while at the nurses’ station, waiting for them to finish documentation in some of the patient’s charts (attached to the folders) I thought back to what I’d seen of her today. The verdict returned remained the same: approachable.

  Despite what I say, don’t think it all happened like this in my head. Ordered thoughts. Elaborate plotting. Assembling the forms and folders took a relatively short time. Also, there were other lines of thinking: Someone being young in years and in profession didn’t automatically translate to an easier life; What did I know of Dr. Bernard’s personal life?; I couldn’t recall any ring on his finger, but not all married men wore their wedding rings; Would Dr. Aliozor impersonate someone who was possibly having a ward round today?

  I was a mass of indecision and uncertainty as I dropped everything in front of the senior registrar.

  “Nna, thank you,” she said.

  I stuck around, though. Ebuka, a child, helpless on his bed nearby, gave me the resolve I needed. “Chief, I thought Doctor Bernard was the one on call…”

  “She said she wouldn’t be coming. So, Doctor Bernard will take care of the ward round today.”

  Dr. Bernard and Dr. Ujah seemed friends the times I’d seen them together. They looked to be within ages of each other too. I could buy Dr. Ujah asking him for help. Scrambling my words, I went a step further. “Chief was it during the ward round yesterday she said it, and do you know why?”

  “Doctor Egbo, you’re asking many questions o,” she said, scrutinising me. “What are you doing with the information?”

  I shook my head. “Nothing chief.” Please just answer my questions. “I was… worried.”

  Her expression told me she wasn’t convinced. I wasn’t either. “You heard something?”

  I shook my head again. Please.

  “Anyway, I think she said something about travelling today. She told Doctor Mirabelle before she left yesterday. Doctor Mirabelle told me.”

  Dr. Mirabelle is an SR.

  Her answers gave my mind new questions. What had Dr. Ujah told Dr. Mirabelle exactly? Had she mentioned Dr. Bernard’s name or said she’d send someone? Why not any of the other two female consultants? Did she trust Dr. Bernard over them? Perhaps it had been conflicts in scheduling. Had she spoken to Dr. Mirabelle before or after I’d sent those names? Chisom said Dr. Ujah left the hospital around three yesterday, so before. I could see Dr. Aliozor impersonating Dr. Bernard, better since he already had an engagement here. But one could say the same of Prof. Odili. I didn’t know about Prof. Ekeleuwa.

  When the ward round started some minutes later at the corner of the girl with acute severe asthma, one thing was clear to me. My enthusiasm for Dr. Bernard being Dr. Aliozor had plummeted.

  That doesn’t mean I didn’t pay him any attention. In addition, I started praying in my heart for anything from Dr. Aliozor.

  Dr. Ugo presented her history, examination findings, interventions we’d initiated until then.

  Dr. Bernard clarified certain points from her care-takers. “Okay,” he said, foot on the base of the overbed table, hands gripping its sides. “A…”

  “Ten years, Chief,” Dr. Ekumankah said, documenting his review.

  He nodded, sniffling. “A ten-year-old girl who presented… write the number of hours and presenting complaint. History and examination as documented. Plan…”

  His knowledge of paediatric medicine seemed solid, calculations and all, going as far as explaining to Dr. Ekumankah the reasoning behind each step of his plan. Could a family medicine resident master all this in a less than a day? So much paediatrics, and for different patients. Family medicine trainees do rotations under other departments. But not to this level surely, I thought. That’s assuming he’d even returned to clinical practice. He’d been out of the normal residency programme for some time already before we met.

  This story has been stolen from Royal Road. If you read it on Amazon, please report it

  Again, it seemed impossible. Not to talk of how reckless it could be. But… magic.

  "…Doctor Ekumankah, what features would you see in this child that we would need to escalate to the intensive care?”

  “Chief, features?”

  “Yes. Life threatening features.”

  “Okay, Chief,” she said, sounding unsure. “If she wasn’t able to breathe on her own—”

  “Yes. If she can’t speak or cry because of breathlessness. What else?”

  Hesitation. Dr. Bernard carried on before she could answer again. “Silent chest, if the peak exploratory flow rate is less than 33%, cyanosis, bradycardia or hypotension, confusion… Ekumankah, where to?” he asked, hands dancing.

  I twisted my head toward Ebuka’s bed. His grandma was eating vegetables. Last week, in the ground ward round, we reviewed the most pressing cases first. This aside, he was on the first bed, so the ward round should start there normally.

  This woman has forgotten how things run in an emergency. My first thought as she led the way to the other arm of the ward next. Dr. Ugo doing nothing to course correct made me not count this a point for Dr. Bernard being Dr. Aliozor in disguise. Perhaps they didn’t see Ebuka as pressing in the immediate sense any longer. His condition hadn’t changed. Or she just wanted to proceed in a different order. Or… I didn’t know.

  There was minor variation in the review at each bedside. If the patient was new to Dr. Bernard, the registrar would summarise the case until the present point of care. Patient care-givers would make fresh complaints, if any. Some complaints had very little to do with known medicine. Dr. Bernard would ask about outstanding tests and test results, IV drugs that weren’t being administered as prescribed, and so on and so forth. Dr. Ekumankah would document his dictation. Sometimes there’d be questions.

  The mother of the boy who’d presented with multiple seizures (Dr. James had pointed out she was troublesome, during the hand-over) whipped out one sample bottle with a form when Dr. Bernard asked her about an outstanding test from the day before.

  According to the woman, the bottle had been here since, but she didn’t want to distract us because we were busy. Something Chisom and I had asked her about countless times since the hand-over.

  Chisom nudged me with her side to change my facial expression. It was giving off bad vibes. Could anyone blame me? I wish we’d move faster, Dr. Aliozor hadn’t contacted me yet, and anything might happen to Ebuka anytime. God, please let nothing happen to him, I thought. And bring Dr. Aliozor.

  I’d have collected the sample there and then. Dr. Ekumankah preferred we finish the ward round first.

  The boy and one other patient in that area would remain on admission in CHER after the ward round ended. The third one was transferred to the ward. Dr. Ekumankah had discharged the child who’d had AGE earlier in the day.

  I checked the time as we moved to the bed of the girl with nephrotic syndrome. 2:15. I’d take matters into my hands if Dr. Aliozor didn’t show up when we finished the ward round. I didn’t know what I’d do, but… something needed to be done. The girl was to remain on admission. Later, the patient beside her with sickle cell would move to the paediatric ward.

  2:40. Ebuka’s bed at last. We met the grandmother tepid sponging, prompting Dr. Bernard to check the last recorded temperature. 37.60C. Then he summarised the case.

  Next, he addressed Dr. Ugo and Dr. Ekumankah. They wouldn’t encounter such a case in their exams, he said. The examiners usually focus on the common ailments. Nevertheless, rare cases provided a unique opportunity to learn, for those who were willing. He hoped they were willing. And for those who had minds for research. Were they interested in research?

  I think he used this to pass time, waiting for the grandmother to finish

  She complained he wasn’t eating. Dr. Bernard’s reply boiled down to that the not eating was all part of the larger problem. He asked his grandmother if she had been giving Ebuka water as directed; his urine wasn’t still enough. Even if he didn’t wish to drink, she should encourage him. Ebuka would need to do another kidney function test. Finally, he explained how we were doing our best; we could only do so much if they didn’t provide the things Ebuka needed. His uncle recited his answer about their financial situation, that he was doing his best; should he steal the money?; should he return to his job while his mother and nephew were on admission? Then, he stormed out. Dr. Bernard said to let him go as Dr. Ugo and his mother called him back. Dismissing the rest of us, he sat down for a heart to heart with the grandmother.

  “Doctor Aliozor,” I said aloud, watching for any reaction. That part about research… Nothing.

  “Who is Doctor Aliozor?” Chisom asked as we turned away.

  “Not important.”

  The day hasn’t ended. I repeated this to myself, staving off the urge to insult God, to give into despair. The other Prof. was yet to come. If at the end of my shift he hadn’t still contacted me, then… God abeg, help this child na. This condition wasn’t his fault.

  Chisom and I divided the post rounds between ourselves. She thought I was dodging that troublesome mother when I chose the patients around the doctors’ station. She could attend to the two in the other arm of the ward. I convinced her it was a fair trade, especially as the bulk of the work was with the new patient. She agreed.

  That’s how I got to see Ebuka’s grandmother lose it on the consultant some minutes later. “…Doc., a s? m g?, ajuola m aj?j? ah? ?z?!”

  Doc. I am telling you not to ask me that question again!

  What question?

  And his own reaction as both Dr. Ekumankah and Dr. Ugo stood up, alarmed. Putting a hand up to stop them, eyes still on grandma, he said, “Get me things for setting line.”

  In this profession, when a consultant says jump, you only ask how high. Walking to the emergency tray, the senior-looking nurse on duty asked, “Doctor Bernard, kedu colour nke o?” What colour did he want? Dr. Ugo and a second nurse went to assemble a tray with tools for setting line.

  “Chief you’ve found a vein?” Dr. Ekumankah asked, joining him at the bedside, a roll of plaster in hand.

  I’d have jumped as well, but I was setting up IV aminophylline in normal saline for our newest patient. Now, I adjusted my position so I could turn my head either way without seeming too distracted to the girl and her care-givers.

  Dr. Bernard had brought his chair nearer Ebuka’s hand. Ebuka’s grandma was on her feet, the chair she’d occupied now some distance away from the bed.

  “Here,” he said.

  Out of the corner of my eyes, he was tapping the right cubital fossa. But I had to really turn to study the skin around there. What was he saying? The skin in that area was as solid, smooth, and shiny as the skin everywhere else. There were certainly no visi—

  “Doctor,” the girl’s father said. His voice had a bold and learned character. “Why don’t you finish with my daughter then you can watch what is going on over there. I wouldn’t want you to make mistakes.”

  “Sorry,” I mumbled, nodding.

  Luckily my eyes weren’t the only tools in my arsenal. I warned myself not to hope, as the questions, their answers, and people’s movements gave me an idea of what was going on. I knew when Dr. Ugo and the other nurse brought the tray. I knew that the senior nurse had given Dr. Bernard blue and pink cannulas because he’d answered aloud. I knew they hadn’t started by the time I was calculating the drop rate of the fluid on my phone because Dr. Bernard had asked for two EDTA sample bottles. The registrar went to get them.

  Still, hope rose within my chest. Anger melted like butter in a pan. God, let it be.

  I knew when Mr. Peter returned to the ward. I was at the foot of the Ebuka’s bed, standing on the tip of my toes, the overbed table a support. Dr. Bernard was wiping the area with a spirit swab. A make-shift tourniquet was on a part of the arm about eight centimetres from the elbow.

  The part of me that had decided Dr. Bernard was Dr. Aliozor wondered why he was attempting to secure an IV access. I’d told him in the summary our expert cannulators were unsuccessful. Unless he wanted to establish this was a magical case through and through, it made no sense to me. But he’d require magic to do that.

  I wasn’t at all concerned of the how, the body processes Dr. Bernard might manipulate as he wiped the skin again with a second spirit swab. Performing magic adequately on a living body required at least a knowledge of these processes.

  On my mind was that the skin of Kanevorians didn’t respond to magic. That should… Hold on, was the skin there softening?

  My eyes focused on the area as he cleaned a third time.

  “Chief I’m not seeing…,” Dr. Ekumankah began. “Chief! There’s a vein, medial.”

  A fourth spirit swab kissed Ebuka’s skin. The outline of the vein bulged, Dr. Aliozor coaxing forth a change. Coaxing is one way of casting spells, the other being command. With some exceptions, coaxing is better for things more natural and alive.

  Driving a blue cannula home into the vein, he positioned the hand at an angle. Then he brought one of the sample bottles to the tip of the cannula, another hand keeping the cannula in place.

  It was a joyful occasion for Grandma and the uncle, for the hospital staff. It should have been a joyful occasion for me. It’s not that I wasn’t feeling joyful. But it was in like third or fourth place. My worry about what the spell working on Ebuka’s skin meant was number one. What did that say about me?

  Didn’t this mean he wasn’t a Kanevorian? That this was simply another normal case, if obscure. That was good, wasn’t it? It meant there would be one less innocent suffering for the sins of his forebears. It meant there would be no worries about… killing villagers. But… he was collecting a sample. Why?

  Dr. Ekumankah secured the cannula with plaster when Dr. Aliozor indicated the sample was enough. He corked the bottle, turning it over in his hands.

  “Give him infusion PCM, then start on Dextrose Saline. Doctor Egbo, Mr. Peter I’ll see the both of you outside.”

  We followed him out of the emergency room, to the sound of praise.