Chapter 1: The Day Trouble Entered

You never hear of wahala wey fit make even doctor heart miss beat? Na one kain story I carry come today. I still dey remember that time like yesterday—the smell of methylated spirit for hospital corridor, the tired faces of nurses wey dey wait for morning shift. Na the kind wahala wey fit make doctor chest tight small, if person no strong for mind. Sometimes for this our work, na when you don almost finish your night duty, e be like say na that time serious matter go just land.

One old woman fall as she dey ride bicycle carry her pikin go school. As she land for ground, her shin wound small small.

No be everyday you go see old mama for village dey ride bicycle carry her grandpikin, but Mama Idayat na stubborn type. People sabi am say e no dey gree sit down. Dem dey talk for village, "Old woman wey no dey rest, na her leg dey tell story." Rain or shine, she dey hustle, her wrapper always tight for waist, slippers dey clap for ground as she waka.

The wound no too big, e even look like say e no serious. She hiss, wipe her sweat, and mutter, “No be today leg dey pain me. I go still reach where I dey go.” Then she just carry sand and mud for ground, press am on top the wound make the bleeding stop, then she no reason am again.

E still dey common for our side, that local method. Many elders go just talk, “Make I pack sand put, e go hold the blood.” For Mama Idayat, na normal thing. She no even frown face.

Nobody expect say wahala go come. But the wound begin dey swell, dey smell anyhow, even dey bubble like say something dey boil inside.

E start small—just ordinary scratch. But the way the thing swell come dey bubble, e resemble pot of ogi wey dey for fire, small small steam dey come out. If person near am, the smell fit make you turn face.

Before dem know how bad e be, the woman life don nearly finish.

You know as e be for Naija, we go dey talk say, “No worry, e go heal.” But this one no be ordinary matter. Her body just dey collapse.

I still remember that harmattan well—the sun hot die, everywhere dey roast, weather report talk say ground fit reach 40 degrees Celsius, heat wey fit fry egg. Na this kind heat dey help bacteria grow. If wound no dey treated quick, infection go enter sharp sharp.

Harmattan no dey pity. Skin go crack, everywhere dry, but the heat go still roast body. Na this kind weather dey make wahala fast for body, especially when person wound open, bacteria no go waste time, dem go just enter dey do their work.

That day, na me dey on duty. Dem just call me rush come emergency room.

If you dey hospital, you sabi say emergency call dey always different. That day, my phone ring, my spirit just shake. My slippers almost fly as I dey run go ER.

As I run go there, sweat dey drip for my body, I see the patient—Mama Idayat—lie down for bed. Her eyes close tight, she dey struggle to breathe.

Her chest dey move up and down like who dey climb okada for bad road. Na that kain breathing wey fit make nurse begin dey whisper prayer for corner of mouth.

I look the cardiac monitor near her, her vital signs dey drop. Her blood pressure dey shake, na only adrenaline and other medicine dey hold her life. Her blood oxygen dey go up and down. From the look of things, ordinary oxygen no fit help her again.

The beep wey the machine dey do, e dey worry person. Her numbers dey fall, small time you go hear nurse dey murmur, "Jehovah, take control."

I rush ask her family wetin happen.

As I talk, na sharp Yoruba-English I take yarn. “Who dey here for am? Abeg, tell me wetin happen quick!”

Her son, wey fear don catch, begin explain:

The boy mouth dey shake as he talk, voice low. “Doctor abeg, na this early momo e happen. Mama wan rush drop Sodiq for school, na so tyre slip, sharp stone cut her leg. The pikin dey okay, na Mama leg dey wahala.”

That morning, Mama Idayat wake early carry her grandson go primary school for bicycle. As she dey distracted, the tire slip, she fall. One sharp stone tear her shin, but the small boy wey dey behind no get anything.

Na village life be that—person dey always multitask. As she fall, the sand sharp, but she no gree make pikin late. Na strong woman.

Because she wan rush drop the boy for school, she no take the wound serious. She just pack sand and mud from ground, press am on top the wound make blood stop.

People for our place dey believe say earth get power to stop blood, so e no too strange if person do am. Mama just dey hurry.

For village, e no too strange—people dey use sand or charcoal ash take stop blood, na old method wey people dey use since. Mama Idayat don do am many times before, e dey always work, she never get wahala.

Na old knowledge dem pass down from elder to elder, “If you no get cloth, use sand.”

Normally, the wound go heal after one or two days.

Many times e dey work, but this time God hand no dey there. She just believe say e be like before.

She rush drop her grandson for school—late no dey her dictionary.

Mama Idayat no dey ever let pikin late. She dey proud say her pikin never miss morning assembly.

But after, she notice say her shin dey somehow.

She begin dey feel small wahala, like say pepper dey touch her skin. That kain discomfort wey you go just dey manage dey waka.

Her left shin begin dey scratch her, sometimes e go stop, sometimes e go start again, but she manage am. She remember say her son never chop after he return from farm, so she still dey do housework.

You know as mama dey be—no matter as body dey, housework must complete. She dey turn amala, dey wash plate, even sweep compound. The pain dey hide for inside body.

Because of plenty work, the scratching no too worry her.

She just dey hum old song, dey endure. For her mind, she dey reason say pain no dey kill woman wey don born five children.

She wait make her son and daughter-in-law come back from work. Dem notice say something no right—she dey scratch her wrapper anyhow. Dem ask am wetin dey happen.

For our place, if you see person dey drag wrapper like say na tiff dey hide inside, na sign say body no pure.

Mama Idayat talk say she fall, small wound dey her shin. She say no be big thing, just say the thing dey scratch her well whenever she get small time rest.

She use her old wisdom cover face, “No be anything,” but na so old people dey always talk. Dem no like show weakness.

Her son and daughter-in-law still fear, dem lift her wrapper check—wetin dem see shock dem.

Even before dem open the wrapper finish, the smell don hit them like rotten bean soup. The sight na another thing.

The wound dirty, sand and mud full everywhere. Some kind sticky water dey come out, the skin around am red and hot.

Na so dem know say matter don pass normal hand. Even small pikin for house cover nose.

Her son no waste time, carry her for okada go the village health center.

You know as okada dey, e no dey waste time, na so dem zoom, dust dey fly for back.

The old community nurse look the wound, frown, talk say the thing pass her power. She tell dem make dem rush go general hospital for the next town, no waste time.

The nurse na old mama, head tie full, glasses for nose. She just shake head, adjust her headtie, and point road, "No look back o, make una dey go now now."

Her son quickly carry her reach general hospital for Oke-Odo.

No be small journey, but for Naija, if wahala come, you go find road.

There, doctor no waste time. He tear her wrapper, see the wound for outside her left shin, about two centimeters long, mud and stone full everywhere, infection don set.

Doctor just shout, "Nurse! Bring disinfectant, bring gauze!" Dem know say time no dey to waste.

The emergency doctor clean the wound with disinfectant, use tweezers pick all the stone and sand commot.

Na so dem dey do—one nurse dey hold torch, one dey hand tool. E be like say dem dey do mechanic for leg.

After dem remove all the dirty things, na that time dem see as the wound bad—everywhere red and swell, the skin edge don dey black, smell wey dey come out na that kain one wey fit clear compound—like when beans soup spoil for sun.

That kain black edge dey always make doctor fear. Smell sef na pure sign say wahala dey.

Doctor quickly clean the wound, cut the black skin commot, wash am many times, until the smell reduce before he sew am close.

If you dey there, you for see as them dey sweat, dey pray make wound no get another surprise.

As e be, only about six hours don pass since the injury. For emergency wound treatment, if dem treat wound within eight hours, e fit sew am.

Dem dey call am "golden time" for hospital. If you fit reach before e pass eight hours, hope still dey.

But as the redness and swelling bad, the doctor no wan take risk. He admit her give her drip—antibiotics and medicine to fight swelling, just to play safe.

For Naija, if case dey hard, dem go just "admit" the person make dem fit monitor am. Nobody wan hear say patient collapse for house.

That afternoon, dem do blood test: normal bloodwork, CRP, PCT, ESR and other infection markers. Dem also collect sample for wound bacteria test.

Lab people come collect blood, sharp sharp. For hospital, sample go, sample come—na so dem dey try catch the wahala.

She start dey collect drip: cephalosporin antibiotic, dexamethasone (steroid), and vitamins. This three-drug combo na the normal way wey rural hospital dey tackle infection. E dey work for most cases.

Sometimes na only faith and prayer dey join medicine for that kain rural hospital. As dem dey run drip, dem dey pray make infection comot.

But this time, wahala still dey.

This time around, the normal medicine just dey bounce for the bacteria body, e no dey enter.

By evening, instead of getting better, she worse.

She begin dey talk in tongue, dey sweat like person wey run marathon. Her body dey vibrate.

Her temperature rise, reach 39.5°C, she begin dey talk anyhow.

If you hear wetin she dey talk, you go think say she dey quarrel for dream. E shock her son.

She dey faint, sometimes dey shout from pain.

She go quiet, small time she go just scream. Everybody for ward dey shake head, dey look ground.

Doctor give her tramadol injection, e no work. Dem give her paracetamol for fever, but her body still dey hot.

Na that time doctor begin dey check phone for textbook, dey dial senior colleague number.

Doctor begin panic.

For hospital, if doctor panic, even nurse go dey notice. You go see am for their eye, dem go dey run up and down.

Luckily, the afternoon blood test result come that time.

Na God save. If not, dem for don dey call mortuary.

The result shock everybody.

Even the lab scientist shake head. "Oga, see numbers, this one no normal."

Her infection marker don fly: white blood cell reach 20,000 (normal na under 10,000), CRP, ESR, PCT (na this one dey show serious infection) all don high—PCT even pass normal by hundred times.

Wetin dey inside her body dey cause gbege, everything wey dey show infection just burst top.

Everything show say the infection bad, she fit enter septic shock any time—her life dey danger.

Dem begin dey pray—her daughter-in-law kneel down, dey beg God. Doctor hand dey shake small, because for Naija, if elder kpai for your hand, family meeting fit land you for trouble.

Less than 12 hours after the injury, infection don scatter everywhere. Since the general hospital start, dem never see this kind case before.

Old nurse talk say she never see this kind thing since she dey work—say devil don pass express for this case.

Chief Matron see say dem no fit handle am again.

She no even argue, just carry phone, call teaching hospital. She sabi when to surrender.

The woman get one rare, stubborn disease. The hospital no get all the things wey dem need. She order make dem rush her go teaching hospital for Ibadan.

Ibadan teaching hospital na the place wey big cases dey go. Ambulance no dey waste time once dem hear that name.

Ambulance come carry her reach our hospital. Ambulance dey bounce for pothole, horn dey shout, people dey clear road—na so dem rush reach Ibadan.

I see as dem rush enter, the paramedic just dey shout, “Doctor! Doctor! This one serious o!”

As I look the woman, see how she dey struggle to breathe, check her test result, I just take deep breath.

As I stand for door, na so my mind begin dey do mathematics. I know say any small delay fit mean funeral.

The thing bad and serious—no time to waste. This one na real challenge.

My spirit dey ginger, but fear still dey. Sometimes, you go reason say if you no act fast, person fit kpai for your hand.

The ambulance ECG machine just dey beep, dey warn say her life dey hang. If I no careful, she fit die for my hand—and nobody go sabi the real cause.

For Naija, if patient die for your hand, especially elder, dem fit call meeting for you. So, tension high.

From my experience, I suspect say na special kind infection—bacteria, virus or another thing—I never sure.

All the signs dey point somewhere, but no be every textbook get answer for wetin I dey see.

But the way the thing dey destroy muscle and the tissue around, I know say the infection get power.

Na so some infection dey—once dem enter body, no brake, just dey scatter things like mad goat.

If I wan save her life, I need to find the cause sharp sharp.

You no fit waste one second. Time na enemy.

No delay, I go straight to the source—the wound for her left shin, na there clue dey.

I tie my face mask, wear glove, wash hand well. My spirit dey prepare for anything. Na leg I go face.

I wear latex gloves, begin open the bandage small small. The white gauze don turn yellow-green, slippery and sticky, smell wey nearly make me vomit.

As I open am, one nurse just carry head face window, dey pray for inside.

I no waste time, open the wound.

Sweat dey my forehead, but I steady my hand. I dey talk for my mind, "God, abeg, make my hand work."

Now, no be only her shin—the whole left leg, from thigh reach foot, don swell, look like over-inflated balloon.

The kain swelling na only for hospital you go see. E resemble yam wey dem soak for water overnight, skin just dey stretch.

The scary part be say, the skin wey swell don lose color, e get patches of gray-white and purplish-black.

If you see am, you go fear. No be picture wey you fit show pikin for night.

The stitches wey dem sew before don burst open. The small two or three centimeters wound now dey surrounded by big, rotten skin and muscle, like the mouth of volcano.

Na so we see am. E resemble that old tori of werey wey dey chop flesh for night. The thing wicked.

Pale red water dey leak from the wound, and the worst—gas bubbles dey come out.

That bubbling sound, like Fanta bottle wey dem just open, e dey make person skin crawl.

As I touch the skin, before I press, Mama Idayat shout. The pain too much.

Her voice loud reach corridor. E pain me, but if I no check, wahala go pass hand.

I ignore her cry, check her foot artery—ice cold—blood no dey pass.

If foot cold, na sign say blood don run, leg dey in danger. I just dey pray inside me.

I touch up reach her groin, check femoral artery, thank God say pulse still dey. As long as femoral artery dey beat, we fit still save her leg, maybe even her thigh.

Na that femoral pulse be like hope wey dey blink for inside dark room.

But as I check, my heart jump, I begin doubt myself.

For my mind, I dey reason, “Abi I dey see well? This thing get as e be.”

As I dey press the femoral artery, I notice say the skin dey move under my hand, e dey make some kind crunchy sound. I quickly realize say na crepitus be that.

That sound na only for medical textbook I first hear am. To feel am for real life dey make person shiver.

Crepitus—na that crunchy, crack-crack feeling for under skin, like when you rub hair between finger—na sign say gas dey under the skin.

If you touch am, you go know say no be ordinary swelling. E dey crack like chin-chin for hand.

God abeg! The gas bubbles don break tissue barrier, enter under the skin.

For my mind, I dey beg God, "Abeg, no let this woman leg spoil for my hand."

This kind discovery na big thing—like person wey jam gold for backyard.

For medical world, na jackpot—but na the kind jackpot wey dey make doctor sweat.

Because crepitus na rare but clear sign for one special bacterial infection.

Na only few times you go see am for life. If you see, you no go forget.

From there, the truth about the woman infection clear for my eye.

All my training just begin dey play for my mind like film trick. The puzzle piece fit together.

Gas gangrene—I shout the diagnosis with all my energy.

"NURSE! GAS GANGRENE!" My voice shake for room. Some people stop, some drop tray.

The resuscitation room wey dey noisy before, everywhere just quiet.

Even the security man wey dey door turn, dey look me with fear.

Gas gangrene na deadly, wicked infection.

For this country, once person get gas gangrene, na to pray, run surgery, and fight for your life remain. E no dey give second chance.

The bacteria wey cause am dey multiply fast for body wey no get oxygen, dey destroy muscle, dey produce plenty gas. The gas gather under skin, form subcutaneous emphysema.

This kain bacteria dey waka for place wey oxygen no dey. Na why all those mud, sand and close-up wound na perfect home for am. E go just dey chop, dey produce gas, dey poison body.

When you press the skin, you go feel crepitus—that rare sign of gas gangrene.

If you ever feel am, you go remember am forever. E dey different.

For my mind, I remember how everything start:

Na so I dey play back the day—old mama, bicycle, sharp stone, mud for wound, heat, then bacteria sneak in, no oxygen, infection just explode.

From the small wound, to when she cover am with sand and mud (we create place wey no get oxygen), to bacteria wey grow, produce gas, destroy skin and muscle, then release poison and bacteria everywhere—na full chain of wahala.

Na so one mistake for morning fit turn to midnight prayer point.

As I shout 'gas gangrene', everywhere scatter for resuscitation room.

Everybody just run. Nurses dey pack equipment, some dey call theatre, one dey dial consultant.

Within one minute, dem clear all people wey no suppose dey there, na only me and emergency nurse remain.

You go hear pin drop for room. We dey sweat, dey ready our mind.

We quickly arrange to move the old woman through hospital fast-track go infectious disease ICU for isolation.

Nobody wan take risk. If gas gangrene spread, e fit affect other patients. For our hospital, na serious isolation and prayers follow am. Even as we dey wheel am out, nurse dey sprinkle Dettol for everywhere.

As we wheel Mama Idayat away, I know say this night, sleep no go near my eye—her life dey my hand now.