{UAH} OUR UGANDA DOCTORS AND ME WILL NOT LIKE THIS STORY - Dearest Paul Nadduli - RIP
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Dearest Paul Nadduli - RIP
His name was Paul. Paul N. When I first started working in Uganda, and early in my blogging days, I tried to protect some semblance of patient confidentiality by not using first and last names together. I recall referring to this patient as Paul N. For some reason all that politically correct bullshit just doesn't make any sense to me in a case like this. My patient's name was Paul, Paul Nadduli, and I use his full name out of respect for the dead and his family. I hope they understand.
He was the first patient that Susan and I went to see on Hell Day, which was May 12th, 2010. He was the only patient I had on the male Luke Ward, and it was just to be a quick hello. His family was so gracious that I knew they wouldn't mind a visit from a strange mizungu with a big camera, and it would be a good start for Susan.
From the moment he was admitted, Paul looked like hell. I don't think I ever saw him stand up, and he was too weak to even sit up. He would lie there in the bed listening to his little battery-powered radio. He seemed so polite, so gentlemanly. You could imagine him as a tall, soft-spoken man, a protector, a gentleman. He complained of terrible pain in his stomach and hardly ate at all. There was a cute little woman almost always sitting on the straw mat in the corner of his room, always beaming with friendliness and thanking me profusely with the little english she knew. I always thought it was his mother, but now I'm not so sure, maybe it was his wife, or just one of them. I always looked forward to my visits with him, but I grew to dread them as well as they made me feel so helpless. I knew he was going to die. Well, at least I was pretty damned sure he was, from the first moment I saw him, because he just looked like death.
Paul had full-blown AIDS and, as expected, his CD4 count was in his boots. We assumed the pain in his stomach and his inability to eat were due to candidiasis, aka ' a yeast infection', an opportunistic fungal infection that is common in patients with severe HIV. But this isn't any run-of the mill yeast infection, this was esophageal candidiasis, affecting him from his mouth, down the throat and esophagus, all the way down to the stomach. It is a condition that must hurt like hell. I can't recall Paul ever receiving anything for pain, and certainly not anything (like Morphine, literally impossible to obtain) that would have worked.
Ok, let's not beat around the bush. Paul never got better. He just got a bunch of tests and some medications that never changed his condition significantly. He gradually got worse and eventually died. Well, honestly, I had expected that. But as always, there are some tragic details that make his story so sad. After some ten or so days after admission, at the bankrupt point that I would see repeated in so many of my other patients, his family ran out of money. They asked his doctors if they could bring Paul home, home to die. I was almost overjoyed when I had heard of their plan, as I had little more to offer them, and I was not even feeling like I could provide him with comfort. It was the only dignified thing left to do, and it was the right decision. And surely, why drive your family any further into debt when things were futile?
Paul was to go home the next day. But it was not meant to be. Some idiot doctor must have insisted that he needed a naso-gastric feeding tube place before they would let him go home. Now, in Uganda, they are obsessed with these tiny, largely useless feeding tubes. They shove them into anybody who, for whatever reason, doesn't feel like eating for a day or so. They don't properly educate families on their use, in fact, I don't think the doctors have any idea how they should be used. I've seen well-meaning families pour and squirt all manner of soups and liquids into these tubes, only to have the patient aspirate it into their lungs. If I were to venture a guess, I would guess that it was the Luke Ward intern that ordered the feeding tube. And that would have been my nemesis, Dr. Numbnuts, who you may be familiar with from 'The Foot' and 'Brian's Story'. Well, it seems that in Uganda, dying people still must suffer the indignity of being force-fed. So the night before Paul would have gone home to die, they stuck a teeny-tiny useless excuse of a feeding tube into his nose and started to shove it in, in the hopes it would reach his stomach. They had trouble getting it in, and it was probably curling up in the back of his throat, like it often does. They kept shoving, and I was told they tried a number of times, maybe three or four. They probably did not consider that his mouth, his oropharynx, and his esophagus were raw and friable from the candidiasis. Paul started retching, and retching, and then started vomiting blood, and then more blood. Maybe they even perforated his esophagus. We'll never know.
The next morning, I went to see him. He looked like hell, much worse than the photo below which was taken May 19th in which he already looks pretty grim. If I recall, he also was in pain, and was suffering. And now that he was vomiting blood, he couldn't possibly go home now. His doctors would never allow it. Later that day, Paul Nadduli would die, suffering, in that miserable little room.
very high education. We can call Obote all bad names we have, but the bottom line remains that he got more scholarships for Buganda than all previous Uganda leaders combined. That includes Sir Edward Mutesa, President Lule, President Binayisa, up to and into Ssabasajja Mutebi. Who all happen to be Baganda leaders." MulindwaDisclaimer:Everyone posting to this Forum bears the sole responsibility for any legal consequences of his or her postings, and hence statements and facts must be presented responsibly. Your continued membership signifies that you agree to this disclaimer and pledge to abide by our Rules and Guidelines.To unsubscribe from this group, send email to: ugandans-at-heart+unsubscribe@googlegroups.com
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