ACUTE CAN GET CHRONIC

As I had outlined,this is a #KidneyWednesday post because I won’t have the time to post on Wednesday owing to other commitments.Reports trailing to my desk indicate that I owe you a story.

A rather hot afternoon of August 2017 found me at Kenyatta National Hospital (KNH) in the Renal unit.I was a student Nephrology nurse thirsting and hungering for Renal Know-how.

If you have been at KNH you will agree with me that it is forever a beehive of activities.The renal unit has not been spared from the same.

It teems with patients coming in and out ,others waiting for the very few Hemodialysis machines,relatives too tired do sleeping on the cold benches at the waiting bay;Doctors and other medics coming in and out ,their white lab coats hot on their trail.

Nurses and nursing students crammed in the not-large unit all grappling for knowledge.Other nurses wheeling patients from the wards for a dialysis session.Othersfrom the next door Intensive Care unit (ICU) accompanying their patient who has tubes sticking in and out of them.Suffering personified.

It was in this cacophony of work that I heard ,”Sister was Jumuia,” called out from one of the dialysis beds.

Jumuia is the hospital I used to work in as a Nurse-Midwife before coming back to KNH school of Nursing to specialize in Nephrology Nursing.

I knew with certainty that it had to be me.I searched fervently for the origin of the voice and that’s when I saw her.

Buried deep in the once-White hospital beds,Ruth looked like she had been sewn into the bed.Her eyes swollen and her outstretched arm fat at the wrists which made it look like a small rungu ya Maasai.

I grasped the arm in a greeting,flashed a smile and started a small talk.Her mother was towering above her trying to arrange the dialysis consumables atop the machine labeled ‘Ruth.’

Ruth had been a patient at Jumuia and she remembered me.She remembered how I attended to her when she was in labor.Usually we forget your faces and names as soon as you leave the ward unless there is something specific about you.

There was something about Ruth.When I was the nurse processing her discharge with her new born baby girl,I asked her to delay going home so that we may monitor her blood pressure.

Antenatally, Ruth had demonstrated a mild elevation in blood pressure according to the Antenatal clinic record she presented.

All through labor her blood pressure was not alarming at all.The obstetrician had not put her on any medication either adopting a Wait-and-See approach.

A quick urine test demonstrated mild protein level in her urine.I escalated this to the doctor on call who had referred her to the obstetrician–again.

That was an year or so before this meeting at the renal unit.I remember her being discharged a day later ,much to my chagrin, through the Obstetrician clinic.I made the mistake of challenging a colleague on why Ruth was being discharged without medication.My colleague quickly dismissed me by letting me know that when I WILL get pregnant,I will understand that raised blood pressure can happen because of the stress of delivery and childbirth.

Children of God,such ancient wisdom isn’t to be engaged any further.

I listened as Ruth narrated to me how even after going home she did not think it was a big deal to have a, “… Little raised blood pressure because even the nurse who discharged me told me it would reduce by itself.I never went to the clinic until after a month,” she paused to scratch the dressing on her shoulder which covered her subclavian Central catheter.

Ruth went to the clinic after experiencing an untold throbbing headache which was unresponsive to paracetamol or Ibuprofen.The Obstetrician admonished her but sent her for a few blood works.

Ruth was in Acute kidney Injury.Dialysis was not recommended because according to what she told me,the attending doctor told her as long as she was passing urine (she was) , everything would be alright.

It wasn’t.

Within an year of our meeting she had undergone all the stages of Chronic Kidney disease and as her file would tell me later,she was in End Stage Renal Disease.

This is a classic example of how ignorant we all are in matters Kidney Disease.

I say this with a lot of understanding that most medics genuinely mismanage patients with some form of Kidney disease leading to Chronic Kidney Disease.

Specialist doctors do the injustice of delayed referrals to fellow specialists.None wants to appear to not know it all.Yet this is what medicine is–dynamic!

If only Ruth,a 32 year-old gleaming with life had received the necessary management I do not think we could have met as we met.

I never saw her again.I am yet to find out if she finally got a kidney transplant.I feel very embarrassed as a nurse who handled her in the initial stages where probably I should have been more assertive in advocating for her timely referral system.

Eve,my classmate,found me crying that day in the linen cupboard and couldn’t help but ask what was wrong.

I explained how a patient I once nurses is lying on the dialysis bed because someone somewhere (probably me) did not play their part in preventing end stage renal disease.

A few hugs did the trick and I was able to sail through the rest of the shift.

Well,Kidney Disease management is multidisciplinary.We can not leave it to one person to manage it.We need all stakeholders on board.

I write so that you as a patient or client may be informed about this highly ignored ,high mortality indiseade in Kenya.I write so that we medics can take more keenness in prevention of Kidney disease whether acute or chronic hence lessen the burden on everyone.

I wrote to challenge doctors and clinicians to not ignore renal function tests.These are important.Let them appeal to your gut when you’re dealing with your patient.You do not treat the results,you treat the patient .

To all team members of the Maternity wing especially in public hospitals,an elevated blood pressure with proteinuria isn’t stress associated with childbirth.

It doesn’t matter how many pregnancies you yourself have had.

Till next week people, enjoy this #KidneyWednesday come early.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s