Being a doctor can be really scary. Worse still is the fact
of your knowledge about the pathophysiology of illnesses and ready access to
more information about them. Sometimes the mantra that it is safer to be
ignorant about some things can be golden here. We encounter different patients daily
in practice, make deductions and treat appropriately. This write up is about
one of such encounters, not so uncommon an occurrence by the way, and not a
hospital encounter.
I had an issue with my car and took it to my panel beater,
thinking it was a problem with my exhaust. I had not seen him in a long while
so I didn’t know anything about his health. After some interactions with him I noticed
he was leaner than usual as he floated inside his T-shirt and used some effort
to talk, he also had this deep seated spirited cough he said had lasted for
more than 2 months with copious sputum production. My heart immediately flipped
at the thought that this guy will handle my car. He had pulmonary tuberculosis
and was not receiving any treatment at the moment. He had started treatment for
it some months before and when the symptoms of cough and copious sputum
disappeared he thought he had conquered and stopped the drugs. Ignorance can
also be a disease. Now the symptoms were back, and I hope not better. He ran
from pillar to post to quell this cough using various over the counter cough
syrups and other medications, of course all to no avail.
I was really disturbed at this double malady, but I had no
choice, he was good at his skill. But how would I ward of the intervening
tuberculous bacilli hovering around after bouts of expulsion from this guy, and
looking for a susceptible lung to perch on, I asked myself? The worst recall
was that a single sneeze can release up to 40,000 droplets, each with the
ability to cause infection, then the low infectious dose (the inhalation of
fewer than 10 bacteria).
First move was face away from his direction of speech and
allow the soothing breeze to blow away the tubercules, hoping one weak, smoke
infested or immunocompromised lung does not acquire it through inhalation – the
primary route of infection, or one inactive lung TB does not get activated
after reinfection by this one. That is ‘saara’ (TB for free) for the person.
That is why we encourage people to stay healthy through feeding and lifestyle.
Second move is ensure the guy goes back to continue his TB therapy, which is
free by the way, in government hospitals, so he can be free to handle my car
the next time I see him. So I made him go back to the primary health centre
around, myself hoping not to have an encounter with him anymore, at least not
any soon. Then one crazy thing happened. The mechanic he introduced to me to
repair my car had not completely remedied the situation so I got stuck on my
way to work and had to send the car back to him. In the annoyance and hurry so
I don’t get to work late I rammed another vehicle from behind. I was sad.
Now my car was to get a good deal of beating from my panel
beater who had TB. This thought kept ringing in my head as I stepped out to see
the extent of damage I had caused. Luckily there was none on the other vehicle
so I just apologized, but mine needed some good work. I was sad again, not for
the damage, but for the encounter I would have, a longer contact this time. Now
he would work on the exterior, then enter the car and try to test it, driving
around in it, coughing and sneezing into his palms and caressing my steering
afterward, spitting carelessly around thereby endangering us. The bacteria can
withstand weak disinfectants and can survive in a dry state for weeks. But one
good news; It replicates slowly, dividing every 15-20 hours…… the imagination
was a terrible experience, and I was just hoping he had started his treatment
so that at least the cough may have subsided. Then I called him and he hadn’t
started.
I really had no choice so I braved it and gave him the car to
work on, not very happy that tubercules will be flying all around within and
outside my car by the time he was done. My imagination ran wild, the
possibility of acquiring TB, the strength of my immunity, my recall that I have
not stuck to taking a lot of fruits and vegetables to enhance my immune system,
the fact that my childhood BCG vaccination should have worn out by now and the
thought of getting another that day, the best ‘mycobacteriotoxic’ chemical to
use to wash my car when he was done with the work. Such highfalutin thoughts
just kept flashing. He could have saved me this stress if he continued his at
least 8-month long TB therapy earlier. Why did he break it? Ignorance. The same
ignorance that would have been safe to the mind that didn’t know the
pathophysiology of illness, which would have thought it was a regular stubborn
cough, the type that he once had, so would not go through the mind torture I
underwent. It is such knowledge that sometimes negatively affects the prognosis
of an ill doctor as compared to the other patient, when he does not believe in
faith because of his understanding of the illness.
Anyway this time I got him to take the treatment seriously
and never joke with TB. I infused the fear of God in his life especially when I
mentioned that if he didn’t start treatment soon enough he would start coughing
up blood. He thought that would be a near-death experience. I also told him he
would be endangering other lives, especially his house mates. What is needed is
a 15minute long close contact to be a potential carrier. So he has gone for a
chest X-ray and sputum tests so as to recommence treatment with a basis, which
he should have started by now. By the way when I later returned for my car I
first opened all the windows so there could be cross ventilation and I started
to imagine again where the tubercules could be trapped, then I had to open all
the doors, then I imagined that his soiled greasy hands could habour live
bacilli and he would have rubbed it on my steering, seat, door, windows, and so
on. I needed a quick fix myself. So I tuned off and just went home to rest, but
not before I reminded him of the fear of God I had infused earlier. Now he has
resumed treatment and the cough is subsiding. He is really lucky the drugs are
still working for him because antituberculous drug resistance is high especially
when not taken correctly, just like other drugs.
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