Tales of the Young Doctor: The Misplaced Case-note

I remember the day I misplaced a patient’s case-note in LUTH. It was a Wednesday afternoon, the sky was clear and blue, the clinic smelled of blood and disease, just the way it always was, and the patient was seated in the waiting area with his mother, as it always should be. This particular patient was supposed to be booked for surgery that week, the doctors take up the sign-out logbook and they turn to me, “Dr Sowole, where’s the patient’s case note?”

A casenote is a bunch of papers that serve as documentation for the conditions of a patient. If you ever visit a hospital or clinic or healthcentre, the attending physician opens a casenote for you, this casenote contains all the findings they make on you, all the test results you take, and all the medical plans they make for you. Your casenote is literally your entire medical record in that hospital, it is so profound, it is even admissible in the court of law as a legal record.

I’m looking at them like, “What? What patient?! What logbook?”. They show me the signing-out log, I see my signature in it, it was literally I who signed out with the patient’s case note many months back. I don forget Pata-Pata. I’m like “Wetin be dis!”, I’m confused but I quickly assume and tell them it’s in my bag, ‘cause my bag then had a bunch of case notes. I look through, all through my files and forms, I can’t find this particular case.

Everyone is looking at me scrambling through my bags. I look up from my bag, my face with a stare blank as the insides of a coconut. Omo!! Small problem don dey oo! I tell them to give me a while, I know where the case note is, I am sure of it; it’s a lie, I’m not. Senior doctors are already looking at me, “Dr Sowole, you know without that case note we cannot do surgery for this patient!”. I’m looking at them like “Nigga, did I ask you people to give me case notes?! You people always give me case note every day, una no get folder?!”. Instead, I say “Sir, no worries, I know where it is”. Lies from my teeth, my chest dey pound but I dey form cool and calm on the outside.

I quickly rush to my room in LUTH, scramble through my locker; I can’t find anything of such. I look through my car; I can’t find it. Senior doctors are already buzzing my phone. The patient is a small boy who needed surgery for a birth defect. I’m answering the phone cooly, “Dr Sowole, where is the case note, the mother is here in clinic waiting to be admitted for surgery, have you found it?!”, they say, I’m there like “Oh, my Chief, not exactly oo. I’m still on my way to where I kept it!”, I’m freaking stalling. I call another senior doctor, “My Chief, I have a small question to ask oo!”, “What is it, Dr Sowole?” she replies.

I begin, “If something happens and a patient’s case note gets missing before surgery, what can we do?”. “In all my years of practice we’ve never misplaced a patient’s case note oo.”, she replies – this is someone who has about seven years of practice – “But a surgery cannot hold without a case note, Dr Sowole. What happened? Did you misplace someone’s case note?”, she asks. I’m like, “No oo! I’m just asking, I’ll call you back, ma!”

Omo! I quickly employ the laws of elimination, If the case note is not in my bag and not in my room or car, then it has to be at home. I don’t carry case notes home, but that’s the only option my brain could think of. I must have broken my own rules at some point in time and carried the case notes to my house.

I go back to the clinic and explain calmly to my Chiefs that e be like say the case note no too dey available right now oo. They say I must go and explain to the mother. Wt*!! The woman has been in the clinic with her child waiting for a while, she has obviously observed at this point that something was amiss. I and my Chief walk up to her and begin to explain to her that we can’t book her child for surgery because we can’t find the case note. Na so this woman burst cry ooo, “Chimmooo!! The enemies have won oo!! The enemies don’t want
my son to get his surgery oo! The enemies have targeted us oo!”

I’m standing there like wt*! Which enemies?! Madam, na me loss your case note oo, I’m not your enemy oo. She’s there in the clinic wailing and rolling, shouting to everybody about how she has been expectant of this surgery for many months and finally, the enemies have caused it to fail. The thing is, a surgery case note has never been misplaced in the unit before, so no one knew Wt* to do. I’m just standing there trying to placate her.

I felt terrible. The woman was crying, the baby too started crying. I’m like wt*! These people load me with so much work I am literally bound to breakdown at some point and now I have broken down and here is the result of the dysfunctional system that cannot rely upon simple e-records. At that point I was Chief House-officer, so a bulk of the work was assigned to me, I was the oldest officer, so I had more documents and forms than any other officer in the unit, I obviously inevitably mixed some shi* up.

My Senior doctor called me to one corner, “Dr Sowole, better find that case note before the Professor handling the surgery hears about it oo, or else all of us are in trouble oo!”, I’m like “Chai!! Why life just hard?!”

Omo, that day, I knew I could drive. I jumped into my car with my ward coat still on. The journey from LUTH to my house takes about 2 hrs. That day, it didn’t. I disregarded LASTMA, Traffic lights, Danfo, I am quite sure I disregarded every traffic law known to man that day. I was speeding my Highlander as if it was a fighter jet. I was overtaking and weaving through traffic like a beast. My phone ringing, the nurses on the ward are calling, they want to admit the baby on the ward but they also need the case note for that. They
can’t give him pre-surgery medications without the case note. Everybody just went mad because of a few pages of paper, that’s the weight of medical documentation. I rushed into my house. Ran up to my room. Started scattering my wardrobes. After all was tumbled upside down and inside out like I expected, not one single case note.

Chai! Omo! Scattered everywhere in the house. No single hospital paper.

My phone was buzzing and buzzing. I just laid on my bed first, let me think. I think and think, I have absolutely no idea where the case note could be. The woman is obviously still crying in LUTH, my bosses call me that they’ve cancelled the surgery and sent the woman home, pending when I bring the case note. I’m like, omo!! Una go cancel a whole surgery because I do small mistake, just small mistake. I was on my bed, dejected and depressed. That evening I had become the harbinger of sorrow to a mother and her infant son.
They call again and say I should not come back to LUTH without the papers. Lmaoo!! I’m already thinking of how I will go and start another housejob in Abakaliki or Nasarawa. Some places they will respect me more, places where surgeons don’t really need case notes for their surgery. They can just open you up like that without documentation, my dream facility where I can never get in trouble.

I’m pondering and pondering. I don’t even remember ever holding the case note, and that’s even the issue. How can you solve a problem whose root cause you have no memory of?

These niggas are calling me every 15 minutes. Different bosses to ask me if I’ve found it. The thing tire me. That’s the thing about government hospitals. You don’t have just one boss, you have a chain and a series of bosses to answer to – Residents, senior residents, consultants, professors. Everybody and you’re the lowest-ranking doctor.

I receive a call from my colleague, Dr Sanni, at this point I’m tired, and the day is almost spent. She says “I’ve found it oo!”, Nigga what?? Apparently, while I was searching dead ends she went to the other clinic to check and found it just lying on the clinic table.

I’m like “Haa! Dr Sanni, you don save my life! Me that I was already planning to go and restart housejob with Boko-haram!”, I don think taya. To find something wey loss na terrible thing oo. The thing be like swear. Especially if it’s something inanimate like a paper, something that cannot talk or move, something you cannot call or command. The paper will just be in one place, you, a living intelligent human being, will be running around like a fool because of a non-living thing.

Omo! That day I did not still go back to LUTH oo. I just stayed at home alone and slept till the next day.

The surgery had to be rebooked for a future date sha, because the case note was found too late.

When we finally did the surgery and the woman was all smiles, she would bring her son to me and be like “Dr, look at your pickin oo! See as he fine!!”

After we found the case note, the boy don turn my pikin. Before, I was an “enemies” that wanted to eat the pikin before oo.

During my time as a doctor in LUTH, I witnessed a lot of things get missing. Not just documents. I have witnessed doctors misplacing a patient’s jaw implants, I even know a doctor who nearly misplaced a patient’s scalp, an entire human being’s head. They keep all sorts of things with junior doctors, at some point, something is bound to get missing.

About Author:

Dr. Sowole (The Redmosquito)
A dentist and an artist.