Stella Dimoko Emergency Room Series -What You See Is Not What It Is....


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Wednesday, November 15, 2017

Emergency Room Series -What You See Is Not What It Is....

Oh Dear!!!!  

Whenever a patient comes into the ER, we know nothing about them unless we ask and get a health history from the patient. 

We ask relatives for a health history if the patient is young or unconscious. Sometimes, patients lie about their health status or conditions so as to extort other family members or get days off from work among other silly reasons I'll discuss in another chapter.

A young girl was rushed into the ER during my shift yesterday. She was accompanied by her mother and father. She was in her late teens. She was pretty with a very long natural hair. On physical assessment, She looked very ill, pale and I could see she had lost some weight as she had loose skin under her arms.

She was extremely weak and dehydrated, her eyes were sunken and she coughed persistently. I told her to lie on the couch as I checked her blood pressure and heart rate while the doctor wrote down some prescriptions and IV fluids which we'll need to rehydrate her. I took some blood to check her sugar level while the doctor inserted a cannula and put up an IV fluid.

The glucometer clicked and the result was ‘HI’. I paused and told the doctor who asked me to repeat it, the result was still the same. A glucometer only reads “HI’ when the sugar level has skyrocketed above 5OOmg/DL against the normal 8O-1OOmg/DL and the monitor can't read it again. That's like having +++diabetes. We feared she would go into hyperglycemic shock.

The doctor asked the father if he was diabetic, he said no, mother also said no. The doctor asked what she ate recently, they said she had only been drinking water for about 7hours that she wouldn't eat. The doctor further asked if she has had any surgery, drugs or fainting episodes, they said no. We had nothing to work with asides the high sugar level and dehydration. 

We gave her shots of insulin and the sugar level dropped slowly. The doctor asked me to do vaginal examination on her, and get swab sample for test that was because the high sugar level will increase her risk for severe vaginal infections. The doctor wanted to be sure there was no yeast infection there too. I told the parents to leave the room while I got a sterile vaginal speculum.

I noticed she was reluctant to spread her legs which I felt as being shy or something so I told her to relax that I won't insert the speculum if I realise she's a virgin. I didn't ask her if she was on purpose. The doctor sat on the table writing on her case note. After much persuasion, she spread her legs and I cleaned the area first. I used my thumb and forefinger to part the labias and what I found out blew me away.

 The vaginal opening looked like she just had a baby. I called the doctor's attention who was equally surprised. We asked her if she had s3x recently, she said no, I further asked if she has had s3x ever, she said no with a very innocent look. I told her she has to be truthful with us. She insisted she doesn't know what a penis looks like. I inserted the speculum and took the swab sample, she didn't feel the speculum going in. I asked the doctor to leave us alone and wait outside.

 I asked her gently if she had been raped recently, she said ‘God forbid’ . I asked if she took any drug recently or if she's on any medication. She said no. The reason why I asked about her s3xual life and drug use was to know if she was using any contraceptive that she was abusing as that could explain the high sugar level. All the young girl answers were No. I wondered why she was lying and it made me a bit angry. I called the doctor and parents in. I didn't tell the parents what i asked her. They looked like devoted Christians and I could see they talked to her strictly and put pressure on her to talk. 

When she was getting the insulin injections, they scolded her for crying in pain . She couldn't look them in the eye. She feared them, even in her state of health. I wanted to reach out to her, she couldn't open up and it made me really concerned. Well, we ordered a pregnancy test and hormonal test which I couldn't get the results as she was moved from the ER to the wards because she became stable.

Dear parents, Kids raised with punitive discipline have tendencies toward anger and depression.
That's because authoritarian child raising makes it clear to kids that part of them is not acceptable, and that parents aren't there to help them learn to cope and manage those difficult feelings that drive them to act out. They're left lonely, trying to sort out for themselves how to overcome their "lesser" impulses. They tend to find love and care from outsiders and friends and could be taken advantage of especially if it's a girl child.

Because kids raised strictly only "do right" when parents are there, they get into more trouble.

They also become excellent liars. The combination of empathy and limits is the sweet spot that raises amazing kids and makes for the best parenting. I can't imagine what the poor girl had been through or is going through and what She'll still go through later in life especially when they find out their “perfect daughter’ isn't complete after all. I hope she gets help very soon. 

Have a good day everyone


  1. Hmmm.....thank God you guys were able to stabilize her sugar level. God bless you and well done. Lesson learnt.

  2. What a pity.

    Most especially our igbo parents. The way they raise children with authority, you find the children finding it difficult to talk to them. children prefer talking to their mates when things go wrong.

    They will tell you if you carry belle, your own don finish? It is just wrong.

    I feel for her. I pray she gets better and go for counselling.

  3. Thank you. This segment is really an eye opener.

  4. Raising a girl child is a very tedious job. I saw lots during my service year in the s/s. Some parents can spoil a child with over pampering all in the name of caring. Train a child in the way of the Lord...and when he grows...?

  5. I have a 13 months old daughter and my parents are yet to know. Writer's last paragraph so true. I can lie for the world.

    How I manage to hide it from them? Story for another day? We talk on a regular base o,I visit too,I don't hide my body oo. Hehehehehe funny but very bad.

    Lesson learnt: I will be my daughter's best friend, tell her to introduce any male friend she has...

    Duties calls

    1. So we should clap for you and blame your parents for you becoming a baby mama abi... Rada rada

    2. Hmmm....Eventually you will have to let them know right?

    3. Dear anon pls send your full story to sdk, so you can be featured on this segment, it's my first time of reading it and I am already in love with it, it's really an eye opener.

  6. Wow I love this emergency room series, very educative...kudos to Stella and the series writer.

    Strict parents most times drive their children into the wrong hands, I made alot of wrong decisions because of my strict parents but all is well that ends well.

  7. "Because kids raised strictly only "do right" when parents are there, they get into more trouble.

    They also become excellent liars."

    This is very very correct...

    So, did the girl finally say what made the hole in her vagina?

  8. I still don't understand the clinical indication for a vagibal examination!!! Unwarranted and inappropriate. In fact, I would report to the regulatory bodies if we went from possible DKA to vaginal exam. No urinalysis, no chest X-ray, no blood cultures. This is clearly made up toxic nonsense that contributes to the risk of women getting abused by caregivers.

    1. Me too @Jona, why run straight for vaginal examination?

      ... Jesus is my worth!

    2. I'm a doc, and I don't know why you will want to do vaginal swab in DKA. Also, she never gave consent and you went ahead! You threw away ethics and the rights of your patient away.... Mehn both the nurse and Doctor needs to be queried.

    3. I mean, I'm not the only one thinking how ridiculous this is. Who gave consent for a vaginal examination or Pap smear?
      What if she was a virgin? Were you still going to introduce the speculum? Abegi

    4. Oga Jona, didn't you see where they wanted to check if she had Vulvo vaginal candiasis, abeg shift. Im sure you re a Johesu member feeling funky.

    5. I am a doctor. Fully board certified and licensed to practice in two jurisdictions at attending/consultant level.
      1. A patient coming in with presumed diabetic ketoacidosis does not warrant a vaginal exam at that stage. It is inappropriate and unnecessary, unless she specifically complains of symptoms in the area. This young girl did not. There are other tests that are far more important that weren't mentioned. This makes me question the doctor and nurse's competence.
      2. The author performed an intimate examination with the patient under duress, without the offer of a chaperone, and most alarmingly, without consent. This is unethical, disrespectuve and brings the entire medical profession into disrepute.
      3. Even if this is a made up morality tale, it's stupid because it normalises abhorrent behaviour and makes people whom may not know believe that a care provider asking to see and shove things up your vagina in the absence of a valid reason and without your informed consent is normal. It is not!!!

    6. @Jona
      You are probably not "board certified in Nigeria"
      In wherever you practice, you do abortions in hospitals, in Nigeria, it is illegal.
      Consent; Yes, considering the girl's age and the mother's presence, she out to have been
      intimated about the nature of the examination to be carried out and a chaperone is needed.
      But as for Diabetic ketoacidosis and the V.E, supposing this patient after treatment was discharged from
      the emergency room and eventually developed sepsis due to vaginal infection? Most girls at that age in
      Nigeria will not ever tell the doctor the truth especially when accompanied unlike where you practice.
      Thus if not thoroughly examined, the whole essence of coming to the hospital is defeated.
      Remember that if you come to a Nigerian teaching hospital, you will not be recognized as a specialist
      you will have to begin at senior registrar level. It is because of those intricate disparities in practice.

    7. Thanks for your post Anon 1.29. Nigeria too.
      Most young women from strict cultures with a certain type of parenting across the world are forced to lie. From Naij to countries in the Middle East to Asia. It's not unique.
      Nonetheless there is no reason to assault someone in the name of she will leave hospital and die from a vaginal candidiasis.
      People deserve a basic level of respect and agency over their bodies, regardless of local factors or nuances in practice. First do no harm. Disrespecting your patient's humanity and putting your need to practice defensive medicine above what is in her best interests (respect, courtesy, agency, unnecrssary interventions) is doing harm.
      There are ways to communicate and get information out without perpetrating violence and abuse of women that is endemic in our society.
      I really believe there is a minimum standard of respect and ethical behaviour we should offer everyone regardless of wealth, age, education, nationality etc. The Nigerian patient is worth that.
      Anyway, maybe the author skipped a lot of information about the entire interaction to get her point across.
      My two cents o.
      A wonderful day to you.

  9. My good God.
    I pray everyday to God to help me raise my unborn kids, what I see and hear these days fear me I swear.

  10. Hmm,I was raised by strict parents and I didn't turn out bad,sadly there is no manual for parenting just trust God and do your best

    1. That's it!

      That's all!

      This story feared me. Poor girl!

      May God help us all parents!

    2. You are just lucky most of strict parents turn out to breed bad & treibble children,

  11. poster, I am waiting for the part 2

  12. Nawah ooh, God give me the grace to train my children well. Fear dey catch me for this present generation

  13. Some parents are inaccessible to their children


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