By Dr Lemma

This is a story almost two decades old but is still fresh in my mind. I was a 4^th year medical student just starting to see patients, eager to appreciate abnormal physical signs which were common as most of the patients sought medical attention late.

An enlarged liver, a huge spleen that can even be seen under clothing, a racing heart and a crackling chest were few of the daily routines ,  and yet a cause of pain and suffering for those who had them.

It was a regular day in Jimma hospital but never regular for a young mother from rural Jimma, Feyate. She was admitted with body swelling and fatigue. There wasn’t much we could do to investigate her maladies; our laboratory was equipped to perform only basic tests such as measuring hemoglobin levels and white cell counts. Our imaging was the good old plain x- ray. It all came down to making sense of the patient’s stories and thorough examination for clues about different diseases. Thanks to our seasoned teachers who thought us such critical skills which I am afraid is getting lost from modern medical education.

Feyate was admitted in one of the medicine floors, a hall crowded with 20-30 beds. I could easily tell she was uncomfortable.

Later that day everybody was talking about an “interesting” physical finding in the medical ward and everyone was rushing to appreciate it.  It was a pericardial friction rub, a sound that is formed when there is irritation between the inner and outer coverings of the heart from conditions like renal failure. I picked up my stethoscope and ran to the medical floor. There were a couple of my colleagues by Feyate listening to the strange sound over her chest.

That is my patient!

I wasn’t happy that I didn’t pick the rub first.

It was pericarditis, an inflammation between the coverings of her heart, which was as a result of her advanced kidney failure. We couldn’t do anything about it.  Dialysis was unthinkable then and is still unthinkable in most of the cities outside the capital.

The senior physician suggested we discharge her home so she could spend the rest of her days with her family.  She knew we had nothing to offer.

 A bunch of young kids

Running around with stethoscopes

Chasing after murmurs and rubs

“I want to see my children,” she said, afraid that she will die far from home.

The dangers in renal failure include very high potassium that could result in sudden death, or accumulation of fluid between the coverings of the heart, or the accumulation of the waste products that the kidneys normally filter that can cause confusion and coma; or the uncontrolled blood pressure, and many others.

I still remember the poem I wrote her that day.

Lijochen salay endalmot (let me see my children before I die)                                       

Tolo awtugn kezih behiwot (send me home)

Eyalech baluan sitimatsen (was begging her husband to take her home)

Sitiwotewit let te ken (day and night)

Yerega tihut menfesua (her quiet and calm spirit)

Bibezabatim abesa (despite her sufferings)

Chirash atawkim maguremrem (she never complained)

“Feyate” bezaw silimlim…. (“I am ok” and back to slumber)

Feyate was discharged the next day and had to take a long horse trip home to be with her family and to be surrounded by her children, her neighbors and her community. Death is always a stranger one can hardly get used to …but when it is potentially preventable, the pain is much more difficult to handle.

Dr Lemma went to medical school in Jimma. He studied Hematology and Oncology at the Karmanos Cancer Center / Wayne State University in Detroit, MI.