A Broken Home

Although on an infusion of the most potent analgesic available, Njaga’s pain and agony only gets worse. He can barely open his mouth to utter a clear word, not even his own name. All that comes from him are the persistent moans, which change in character as the pain waxes and wanes. He has lost control of his voluntary muscles, and his body forms into postures too uncomfortable to bear. His back is highly arched, head forced backward, mouth firmly shut. He struggles to get out of this misery but to no avail. Between the peak moments of intense pain, a disturbing look of anxiety settles on his face, with evident fear of the subsequent episode. One can guess that his family has given up all hopes, believing that his death is imminent.

One of the residents will have to spend what is left of his call in the ICU next to Njaga. Although he had arrived only a few hours ago, Njaga is already the VIP for the night. The resident knows there will not be any sleeping for him but he cannot be bothered. For Njaga is at a crossroad, his prognosis evidently poor and his chances of making it very slim. But the resident will not give up on him so soon, this is a fight he is determined to win whatever it takes. He has no other preoccupation, no other worries; nothing else matters. His arsenal is fully stocked and nothing will make him leave the ICU before 8am the following morning, when he will hand over care to another doctor. Fortunately, the rest of the patients in the ICU are relatively stable and Dr Djiddi prays they remain so.

So far Njaga has only received symptomatic treatment to alleviate his pain. But it is certain that his only chance of leaving the hospital via the front gate and not the back is if a correct diagnosis is made and appropriate treatment administered. Hence someone had to give the history of illness, the main component in making a successful diagnosis. Usually the index patient is the preferred source of information because no one can possibly give a better account of the illness. And Njaga was almost a qualified candidate to be interrogated – he was fully conscious, old enough and did not suffer any memory loss. However, Dr Djiddi knows better than to question him because all that will come out of the interrogation will be worsening of “spasms” and all that they come with. Hence Dr Djiddi turns to the mother, Adja, who so far has been very cooperative and helpful.

There is a bit of a language barrier but the important aspects of the medical history are being elicited and clarified, often with the help of a nurse. Overall the collaboration was superb, and a definitive diagnosis likely. Then the door swam open and a middle-aged, bald headed man gently walks into the ICU. The instant change of look on the mother’s face is enough to tell anyone smart enough to see that this man is an “intruder” whose presence is not welcomed. At least not by Adja. The air around her became still, movements got stiff and a bit of reluctance starts to creep in.

The man introduces himself as Njaga’s father. And intermittently he attempts to give his own response to the questions being asked by Dr Djiddi, his versions mostly incriminating Adja. But what is even more striking is the fact that the parents will not exchange words or looks, not even by accident. A “silent” war is being fought here, and each parent seems to be more concerned with making the other party look guilty and responsible than helping the health care givers bring their child out of his state. The extreme variations in their stories threaten to snatch away Dr Djiddi’s hopes of making a correct and timely diagnosis.

It was when he took a family history that it all made sense. The parents had a divorce several years ago and the bitterness between them has not gotten any less. They can hardly tolerate one another, even though they have both re-married with children. The three kids they had together are fully grown, this 18year old boy being their youngest. But neither the kids nor time could resolve their differences. And right now, not even a life they share can do so!