There Should be Proof

You could say that meningitis is stronger than men,  and maybe that sickle cell disease is crazy. But there should be proof.  Because this left Emeka with a broken nose and a bleeding tongue.

He didn't play football, no one hit him, he didn't fall. But on Wednesday, he just couldn't move his neck, and he slumped during the biology exams. So of course we called it exam fear. As we came into the hospital, drip stands were moving, cannulas had their way into his veins. The nurses and doctors paced from one corner to another.

'Give me the prescription sheet,’ ‘check his temperature and record it,’ ‘What does his pulse read?’. ‘Prepare the oxygen to be administered’

I was there standing and watching as sweat lined my forehead in drops that had the same size as grains of rice. I could barely blink for a long time as I watched the needle cannulas pierce his skin.

“Call his parents,” Mrs Ozioma instructed while handing her phone to me.

Few minutes later, Mr. and Mrs. Eze arrived. They held each other's hand as if both were glued together. These two couples had won various awards including the Parents Couple of the Year, given during the SUG yearly awards.

Emeka's bedside was surrounded by a Chief Doctor, two house officers, three nurses, and his parents whose hands could not unbind. The doctor examined him, and while this went on I heard Emeka complain of severe pain in his legs and hands. His temperature was above rockets, and soon he could no longer reply to questions.

The doctor pressed gently against his skin, and Emeka screamed in pain, checked his eye and discovered his sclera(the white part of the eye) were yellow.

‘Mr. and Mrs. Eze, what are your genotypes?’ he asked.

‘We are both AS,’ they chorused

‘Have you had any sickle cell child previously’
‘No doctor,’ they replied.

The doctor said sickle cell anemia was among the possibilities and ordered investigations to confirm it. He suspected meningitis because Emeka had lost consciousness, and was convulsing. He gave them different investigation forms from his drawer. One was for a Full Blood Count to assess his blood cells and haemoglobin level, another was for a peripheral blood smear to reveal sickled cells, and more papers I couldn't read.

Then he flexed Emeka's hip and knee, and Emeka winced in pain. The Doctor called it the Kernig’s sign.

‘This patient has fever, headache, neck stiffness, and positive Kernig's and Brudzinski's signs.’ He explained to the house officers.
‘Meningitis is a strong possibility, we'll perform a lumbar puncture as soon as it is safe.'

The doctor instructed the nurses to give Emeka intravenous fluids of normal saline, and  intravenous ceftriaxone immediately, because he said meningitis was too dangerous to wait for confirmation; then continue oxygen therapy and monitor him closely.

The next day, the tests results were out, and he was more conscious

'His haemoglobin level had dropped dangerously because of sickle cell complications. We must perform an exchange transfusion ,'

I witnessed Emeka’s pain as the exchange transfusion ran like a controlled replacement. Sickled blood was withdrawn in measured volumes while fresh donor blood replaced it. Throughout the procedures, he screamed, complained of deep pain within his bones.

I watched with tears that blurred my vision. Many questions flooded my mind. How had the signs been missed for so long? How come his parents still went ahead to get married even after knowing what their genotypes were and the implications?

One house officer explained that  they decided to give it a try. Their genetic counsellor said it was a twenty-five percent chance that each pregnancy could result in a child with sickle cell disease, and they accepted the risk. Their first three children were not SS until they had Emeka.  But since  his previous symptoms had always been mild, they chose not to believe he had the sickle cell disease, and continued  living happily as always.

Emeka is currently eighteen years old, now experiencing one of the worst vaso-occlusive crises of his life, as the doctor called it. His parent's hands remained together, none has suggested they let go. They had  completed their secondary level of education together. They had received a Couplet award in their home church. I've always admired the way Mr. Eze looks at his wife,  smiling at her, looking as though his breath came from there.

But today, a little hatred formed in me. Hatred for ignorance, for the joy that still existed on their faces. Hatred for those hands that were stitched together, hatred even for the peck they exchanged while someone fought for his life.

Emeka started convulsing violently. He bit his tongue hard and started bleeding. Even while the nurses suctioned his airway and tried to prevent further injury, he was strong enough to hit his head on the bed stand, and his nose lost shape.

I heard Emeka's mother whisper : 'Meningitis is really strong, Doctor.’

I didn't agree. During the doctor's investigations and questioning, Mrs. Eze explained that Emeka had not completed his childhood vaccinations because there had never been enough money for transport to the Primary Health Centre. She could barely remember which vaccines were missed, but she knew they were not completed.

I still couldn't call Meningitis strong because Emeka has complained of recurring ear pain, but didn't get it checked in a hospital. I encouraged him to report to the school clinic, but he said he couldn't afford it.

When the patient beside Emeka described sickle cell anaemia as a crazy condition, I still couldn't agree. Because the proof didn't say so.

There was no proof that sickle cell disease was insane or that meningitis could win the human race in place of us.

But there was proof that two people who knew they were both AS still chose to marry, there was proof that a vaccination schedule was left unfinished. There was proof that months if ear pain went unattended, there was proof that warning signs were dismissed until they became emergencies.

So, no I could not call the disease strong. Not while ignorance had been its coach, and poverty its sponsor.