8 Minute Read
“I am well… in Jesus name,” came my mom’s soft voice through the phone. She sounded faint, as though she had just run a marathon and was finally laying down to rest.
“What’s wrong, mom?” I asked, knowing that when she said things like this, it usually meant something was not well. I was frantically pulling on my scrub pants, about to be late for my night shift.
“Ehmm… well, just having a bit of belly pain. I haven’t gone to work for the last two days –”
“Wait, WHAT?!” I asked incredulously.
To understand the significance of this, you must understand my mother. She was the kind of woman who worked 10-hour overnight shifts at a hospital as a microbiologist, then came home in the mornings to sleep on a make-shift mattress concocted from comforters and pillows in her walk-in closet (there was too much light in the bedroom), then woke up 4-5 hours later to homeschool my brothers and me in the afternoon before getting ready for work and doing it all over again. GAAHHHHHH I get exhausted just thinking about it. Even with all of that going on, she rarely, if ever, missed a day of work.
Now, many years later, my parents had moved back from Atlanta (where they raised us) to Nigeria. My mom was finally doing what she loved, teaching at a university not too far from the town where she grew up.
“Mom,” I said, trying to level the worry out of my voice. “Describe the pain to me.”
She said it was “all over”, and then mentioned that she had already seen two doctors, both of whom had done an ultrasound of her abdomen in their separate clinics. They both told her they saw an enlarged appendix with surrounding fluid, explaining that she had acute appendicitis. She was given antibiotic pills and told to return in two weeks… by both doctors.
I sucked in my breath, struggling to focus on the road as I sped to work. The sky was a gorgeous pink and orange portrait of sunset, but I barely noticed. ACUTE APPENDICITIS?! WHATTTT?!
For some background, appendicitis is a condition where the appendix (a small pouch of the large intestine) becomes inflamed. It’s considered a surgical emergency because if it goes untreated, the appendix can rupture and lead to sepsis, a life-threatening illness where the immune system causes inflammation throughout the entire body. Typically when someone comes into the hospital with appendicitis, they are immediately rushed to get a CT scan of their abdomen and then admitted for IV antibiotics at the least. More often than not, they are taken to the operating room to get their appendix taken out right away. This is why I was completely confused that two seperate doctors told her she could go home with pills, and come back for a checkup later.
But then again, was I really confused? Unfortunately, the health-care system in Nigeria is not currently in the best shape. Over the years, I had heard many horror stories of distant family members who died in Nigeria because of completely preventable medical errors. I was there the day one of my medical school professors learned of her mom’s unnecessary death due to the bravado of a physician who had refused to follow protocol. I had personally seen people waiting for hours at the side of the road for emergency services after a bad car accident. I knew that even when a major hospital had enough CT scanners or other imaging devices, they were often not working due to lack of maintenance. So in a sense, I was thankful that no one had rushed my mom to surgery. In fact, I desperately wanted to avoid her going to surgery in Nigeria.
At this point, it’s important for me to acknowledge the many amazing healthcare providers in Nigeria who provide the best medical care possible, despite often less-than-ideal facilities and a relative lack of resources. Also, to be fair, I have certainly seen patients have negative health outcomes due to medical mistakes in the United States… but there are levels to this. The frequency is less than in Nigeria, the facilities are better, and there is a system in place to correct mistakes or discipline the perpetrators if necessary.
As I parked at work, I asked my grandmother to get my mom’s vital signs (temperature, blood pressure and heart rate) taken again. They were all normal. I had to make a decision. Should I let her stay in Nigeria and just watch and wait? Or send her to a big university hospital and try to get a CT scan to better evaluate her appendix? Or fly her to the US immediately? There was a five-hour drive from the city my mom lived in to the airport in Lagos (a larger city), and then a 12 hour direct flight from Lagos to the US. What if her appendix were to burst and she were to develop sepsis (which could lead to death quickly) while on the plane? The way I saw it, her having surgery in Nigeria was a worst case scenario, but if she were to get worse and need emergency surgery while she was flying over the Atlantic… I would never forgive myself.
My head was spinning as I half-listened to one of my co-residents giving me information on her patients from during the day. As soon as I could, I ran to the bathroom, locked the door, and called two of my uncles (both physicians) to get advice. “I support your decision either way,” one of them said hesitantly, “But understand that flying her here is risky. You know, there really ARE good surgeons in Nigeria, Tewa.”
“I know,” I said. “But what would you want if it were YOU?”
He was silent for a moment. “I’d want to be in the US. But I… I really don’t know.”
I was torn. Both decisions had potentially terrible outcomes and I just wanted to cry. But I needed to stay calm so I could think. So instead, I prayed. I guess I half expected some type of sign to tell me what to do.
And then I prayed again.
No specific answer came. I’m not sure what I was expecting to get from God, but I figured I would just have to make a move.
Deciding to go with my gut, I pulled out my phone and looked up flights. I freaked out for a split second when I saw the prices, but then got it together. There was no time to call my dad and brothers to explain the situation and coordinate a group payment; if she was going to get on the next available flight, I needed to handle it right away. There were cheaper flights with layovers in eastern Europe and northern Africa but I immediately shot those ideas down. The only thing worse than her having to get surgery in Nigeria would be her having to get surgery during a layover in Morocco somewhere where she didn’t know anyone, or have any family to check on her.
I figured she should go to Atlanta. I was working 100+ hours a week in residency in DC, and didn’t know how much attention I would be able to pay to her if she needed surgery. Atlanta was where my uncle and aunt (her sister) lived. They would have more time to check in on her while she was in the hospital. So I bought the next direct flight out of Lagos for that evening, and then called my mom back. Her vital signs were still normal.
The whole 12 hour flight to Atlanta I was STRESSED. I prayed. I cried. I stalked the flight progress on Delta.com. My resident told me to go home early once I told her what was going on. She could see that I couldn’t focus on patients, and luckily it was a relatively calm night.
When my mom called me to let me know she had landed in Atlanta, I thought my heart would simply burst with joy. Oddly enough, her voice sounded peppy and energetic, as though she wasn’t sick at all. I had mixed feelings… grateful that she was OK, but then wondering if I had overreacted. Maybe she would get to the emergency room and there wouldn’t be anything abnormal on her CT scan at all. This would be a pretty expensive vacation to Atlanta, I thought with quite a bit of guilt. My cousin picked her up from the airport and drove her straight to the hospital.
The events that followed happened pretty quickly. In the emergency department, a CT scan showed severe diverticulitis, inflammation of small out-pouchings in the wall of her large intestine. Due to all the inflammation, she had also perforated her bowel wall and developed abscesses (meaning that the wall of her large intestine had ruptured, leading to more inflammation and the development of multiple confined pockets of pus).
When I heard the news, I was shocked. Nothing was even wrong with her appendix! What if someone had taken her to surgery in Nigeria to take out her (normal) appendix, and then closed her up without actually fixing the problem??? She would have had continued pain due to the ACTUAL problem, but it might have been attributed to normal pain after surgery. It could have taken a long time before anyone realized her appendix was not the culprit, but by then it might have been too late. She could have literally died. In Nigeria, on the plane, in the car on the way to the hospital… Her situation was significantly more dire than her clinical presentation. Multiple doctors at the hospital came to look at my mom after seeing her scans, saying it was a miracle that she did not become deathly ill before this point.
I won’t go into the details of her treatment because that’s her personal business. Just know, everything went well. The surgeon on my mom’s medical team was super gracious and kept me in the loop, willing to talk to me on the phone when he came to see my mom daily on rounds, knowing that I was going crazy being so far from her. I wanted to know everything, every day. Yeah, basically I realized that I was WORSE than those patients’ family members I had always complained about for all their meddling. Whoops. “Your mom tells me you’re going to be a resident at Harvard,” he said. I could imagine my mom’s beautiful face beaming with pride.
After the situation was over, my mom’s siblings and friends alike called me, sometimes crying, to thank me for taking care of her. I felt weird hearing these thanks; as a general rule, people tried to do what was best for their mothers’ wellbeing, so I didn’t feel like I did anything special. I also felt guilty knowing how risky my decision was. Guilty knowing that everyone only thought it was the right decision because she ended up OK, but things could have easily gone another way. I thanked God profusely for her life, but even felt guilty doing that, knowing how many others had lost their lives in America and abroad due to less-than-adequate medical care. It wasn’t fair. It just wasn’t.
I write this story overwhelmed, thinking about the possibility of things having gone differently. I know everyone thinks their mom is special but… MY MOM is special. My mother… who is somehow also my sister and my friend. The woman who makes peach cobblers that taste like home, the one who didn’t think twice about giving one of her kidneys to save her sister’s life, the one who picks up the phone in the middle of the night to hear my worries, the one who cooked a week’s worth of food on Sundays growing up, the one who loves pecan pie, and Oprah, and somehow knows all the celebrity gossip. The woman who worked relentlessly to get her masters degree, PhD, and then to finally open her own school in Nigeria. The woman who, along with my dad, showed us the world through books, and then through travel, and then through encouraging us to be whatever and whoever we truly wanted to be. The woman who reads every one of my blog posts and leaves me voice notes with her enthusiastic reviews. The woman with unwavering faith like a shield for my mind, full of doubts. My mother, the woman who responds to my “I love you”s with “Not as much as I love you.” I’m not sure how that can be true, but she says I’ll understand when I become a mother.
Happy Birthday, Mommy. Here’s to long life, good health, and prosperity.
Until next time,