When you are the unidentified patient

Dr James* was headed to a night shift in the intensive care unit (ICU) at his learning institution. He was a postgraduate student taking his residency specialisation in anaesthesia and critical care. He was in his final year, counting down seven months to his final examination before he bid the institution goodbye.

On this particular day, James didn’t have his car. It was giving him trouble and was at the garage. James decided to take a matatu to the hospital after grabbing a quick bite at his favourite diner near the house. His shift started at eight in the evening and he figured he had ample time to get back to the house and grab his backpack.

James and his wife had settled down in a different town about 300km away, a place they considered ideal to raise children. When James got a scholarship to go to school and pursue his passion, they agreed that he would relocate alone for the three-year residency period and then get back home once done. This was why he lived a bachelor lifestyle, residing in a simple bedsitter, eating most of his meals from the diner and spending more time at work and in class than at home.

Half an hour later, James stood at the bus stop waiting for a matatu to the hospital, 15 minutes away. It was nightfall and the city was cloaked in darkness, interrupted by the street lights and the cars speeding by. James entertained himself by watching other people at the bus stop.

There was the heavily beaded gentleman in a Kanzu, likely a madrasa teacher heading home from the nearby mosque. There was the young couple, college students heading home after class. There was the middle-aged lady with a huge basket of groceries, too much to be for domestic consumption. He mused that she may be running a restaurant business and was from the nearby market to stock up.

He was so caught up in his observations he did not look up to see the approaching matatu. By the time he registered the screams and shouts of panic around him, he looked up to find the monster literally in his face. He never had a chance to scream. The out-of-control matatu ploughed into him, tossing him a few meters away, across the trench, slamming him against a tree. His last thought was that he was dying and his family had no idea.

At about 9pm, the accident and emergency department was abuzz with ambulances and police ferrying in victims of a road accident that happened earlier that evening. Many were suffering soft tissue injury and minor fractures.

Though they were in pain, they were coherent enough to narrate the ordeal. They gave an account of how the matatu they were riding in, in an effort to bypass the traffic, was driven off-road, swinging dangerously due to lack of space, leading to loss of control. It ploughed into an innocent bystander at a bus stop before hitting a solid concrete pillar that brought it to a halt.

The said victim was unconscious, with his face swollen and eyes glued shut. He had suffered multiple fractures from the skull to the ribs, right arm and leg. He was hooked up to machines at the emergency section and the doctors had to intubate him to support his breathing as his lungs threatened to collapse.

He had no documents on him hence there was no way to identify him. The nurse immediately labelled him across his forehead and his chest as an Unknown African Male, together with his medical records number and date and time of admission. The poor patient had to undergo multiple tests and had to be reviewed by a multitude of specialists in an effort to piece him together.

Thirteen hours later, the Unknown African Male had undergone emergency brain surgery to evacuate the blood clots in his brain to relieve the immediate threat to his life. He was then transferred upstairs to the ICU for critical care. It took three days for the bruising and swelling of his face to go down enough to identify him. His colleagues in the ICU gasped in shock to realise the Unknown African Male was one of their resident doctors in training!

His terrified wife was received in the ICU the very same evening, having gotten over as fast as she could after a call about her husband. She needed to formally identify him so as to change his identity status as his next of kin. James took 10 days to fully regain consciousness.

During this time, he had undergone two additional surgeries for his fractures and was now on the mend. He was overwhelmed when he opened his eyes and saw his lovely wife seated next to his bed looking like she hadn’t slept for days. He knew all was going to be well.

James’ scenario is quite commonplace in our referral hospitals. Most patients are brought in unconscious with no means of identifying them, ending up with a piece of strapping on their forehead, simply labelling them as Unknown, Jane Doe or John Doe.

The hospitals are left to rely on the next of kin to come looking for them or the police department to try and identify the patient by use of fingerprints.

This can happen anywhere, whether a few meters from home or miles away even in strange countries. Lack of identification also means the inability to trace your family and inform them of your whereabouts. James’ wife was beside herself in worry when she was unable to reach him on phone for three days.

His colleagues in ICU cursed all evening when he did not report on duty and was not reachable on phone. The head of his team was worried because James never missed a call to  duty and always called in if he was running late. Unfortunately, no one knew whom to ask or even where he lived.

For James, the journey to regaining full health was a long, tough one. He, however, vows to give extra attention to all his patients who show up unidentified. He has first-hand experience of what it means to be one!
Dr Bosire is an obstetrician/gynaecologist