Bitter Bitters – A Must Read Story

BITTER BITTERS

As3m b3n kraa ni a? This little boy won’t allow me to put things together. I’m getting late for work.

I checked the time and realised it was 7:24am as I rushed out of the room and sped off in my car to work. Soon after they had taken up from the night staff, I arrived at work.

I quickly skimmed through the folders to familiarize myself with the cases for the shift and got up from my seat to greet my patients. I’m sure that alone brought some relief to some of them if not all.

I asked relatives who were with patients to excuse us; I just don’t know what the problem is with relatives. They know when they are to come visit and when they are to go out, but as Ghanaians as we are, they would wait for a nurse to come and ask them out.

That is when you would be the enemy for the day.

“Madam, s)re pie wai na aserafo) time aso. Yehia wo a, y3b3fr3w wai,” I told my patient’s relative who had reluctantly sat in a plastic chair.

The manner in which she got up said a lot but as a nurse, I ignored many things. They really didn’t matter much to me.

I went back and asked my junior colleagues to assist with wound dressing since we had two patients on the ward with cellulitis. We had to dress them fast before ward rounds since none was for inspection that day.

“Dear, I think one is due for medication at 8:00am. Please check and administer it for me,” I asked one staff nurse.

After we were done dressing the wounds, a staff from the OPD came in. As usual, they were bringing a patient. We quickly received him and put him in an already prepared bed.

Orientation and the necessary things such as checking of vital signs and administration of necessary medication were done.

“Madam, please come and have a look at something,”the new patient’s relative said with a soft voice.

I followed her with the patient’s folder in hand.

“Madam, he’s been groaning for some time now. Please what actually is wrong with him?”she enquired.

“You need to tell me what is wrong with him and why you brought him here, then I would educate you on it dear,” I replied. “Hmm madam”, she started…

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“Hmm madam”, she started…

He is my husband. We’ve been married for eight years now but for the past year, he’s been complaining of severe abdominal pain. Each time I tell him to visit the hospital, he rather goes to buy paracetamol. Hmmm, madam, he wasn’t like this when we got married oo, but look at him now(pointing to the wasted body). He has lost weight drastically. His abdomen has become big and I know there’s more to come. The last time I forced him to come to the hospital, we were told he was anaemic. He doesn’t eat. The worst of it is that he takes alcohol breakfast, lunch and supper. He can’t even walk for five minutes. The least thing he does, he complains of fatigue. Madam, please look at his feet and ankles. Are they swollen or what? I just don’t know what to do again. The doctor refused to tell me what was wrong with him. We were told to go for a scan and they also didn’t tell us anything.”

“Yes madam, I’ve seen the scan. Now take it easy. It’s my work as a nurse to educate you and tell you the way forward. You are my reason for being here. I love all you said about him, because that has made my work much easier.

From all you said, the scan and diagnosis, our father here is suffering from a condition called liver cirrhosis, otherwise called hepatic cirrhosis. It doesn’t develop in a day so thank God you said he’s been experiencing it for the past year. It’s a progressive disease which is characterized by inflammation and degeneration of the liver. Excessive alcohol consumption is a cause of it. With the alcohol, consuming it with nutritional deficiencies is even worst. As you hear among most people, especially the youth, various forms of modern day ” bitters” are consumed each passing minute in large quantum as these unsuspecting youth fall prey to the various marketing strategies employed by the marketers who promise sexual enhancement among other effects.

Frequent consumption of drugs such as paracetamol and chloroform is another cause. We almost always abuse over the counter drugs, especially ones from the aspirin family such as paracetamol to mention the least, since they are readily accessible and affordable.

We have other causes such as billiary obstruction and cholecystitis, but will center around alcohol consumption and intake of drugs since that’s what our father here has been doing.”

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… alcohol consumption and intake of drugs since that’s what here has been doing.

When this disease comes up, one may have abdominal pain as a result of rapid enlargement of the liver, ascites, which you described as big abdomen. This is as a result of fluid rich in protein accumulating in the peritoneal cavity(the space within the abdomen) due to failure of liver function. There is anemia and weight loss as a result of gastrointestinal malfunction, together with poor nutrition intake and impaired liver function.

One may also develop haemorrhoids(pi

les) since the oesophagus, stomach and lower rectum are common sides for blood vessels.”

“Yes yes, he has hemorrhoids but didn’t know it had anything to do with this,” she said.

“Okay so that’s it. What you seeing on the feet and ankles is oedema. They easily get tired and weak. The weakness increases leading to depression, wasting, coma and eventually death. Now, the doctor told you to go take a CT scan. This scan determines the size of the liver and it’s irregularity ( nodular surface). There are other investigations such as liver biopsy which determines the abnormal structure of the liver. With this, there is high risk of bleeding in the presence of clotting defects. There is another common one which is the test for serum hepatitis B surface antigen (HBsAg).

Once he’s here, we are going to monitor his vital signs which are the temperature, pulse, respiration, blood pressure and report any deviation. We will pass urethral catheter to maintain strict fluid intake and output, meaning we will restrict fluids. He would be weighed daily and his abdominal girth;that is the size of the abdomen also measured to ensure we are on the right path and as such losing the right amount of fluid.

You would also do your part by preparing high calorie diet(energy dense meal) which is made up of high carbohydrate, low fat, low sodium and low protein.

“Hmmmmm,this isn’t that easy but with God, I would be able to do it,”she said.

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“Hmmmmm,this isn’t that easy but with God, I would be able to do it,”she said.

Yes…with God, he would be fine. We will soon pass nasogastric tube which is the plastic tube you see in other patients nostrils. This would help in gastric decompression. Just take it easy. It’s well. All he needs to do now is to avoid the consumption of alcohol. His drugs would be administered accordingly.

“But madam, it seems the drugs are many…and with the alcohol, can he stop taking it? I doubt oo. He takes it with a co-tenant. Unless he doesn’t see or hear of any new alcohol in the market, he would go in for it. He tells me it’s good for the system. The co-tenant also tells me it heals internal ulcers. I’ve tried my best but it seems my best has been the worst. They say it’s an aphrodisiac too.”she chipped in.

“Hahaha, eeei then you both are really enjoying in the room,” I jovially replied.

“You are here talking of enjoyment. He hardly stays home. These young girls are the ones suffering. I’ve tried my best as a wife to talk to him but he sees me as a woman who has no authority in her matrimonial home,”she said.

“Don’t worry. We are here to help him psychologically too. With the drugs, they all have their work to do. Some are being administered to manage the ascites, some are to fight infection and others serving as vitamins to aid in the recovery process. They all have their roles to play.

“Thank you madam. You indeed are a nurse. God bless you,”she said. I responded with a big Amen.

“…but please wait. You look familiar. I don’t know where I know you,”she said. “Really? I do travel a lot but I mostly go to Nyinahin because that’s where my husband lives,” I replied.

“Yes…then I know you. I met you in a vehicle where you took your time to educate us on a condition called hepatitis B. I loved it. God bless you,” she continually showered praises and blessings on me. I was full of smiles as I went back to take my seat.

“Eu, are you ready?”that was the doctor on duty coming for rounds. “Yes”, I said getting up from my seat to follow him with my colleagues. Though the day hadn’t ended, I felt it was going to be good one.

The End

©Abhynha Yankey

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