The Decision That Hurt And Hunt

1st January 2022.

It was my last days in the university. I had completed all course works, all results were out, clearance completed, I was preparing for service ... it was during one of those days that step-mum came to my room, she needed to discuss something very important with me, something dear to her heart.

She said she wanted me study medicine. She was going to sponsor me. She needed me to become a medical doctor. She said, 'I want you to use this brilliant brain for Medicine'. This was 2012. She had always wanted one of her me to be a medical doctor.

But all I ever wanted to be was an Engineer. I had no interest in Medicine. On 17th October, 2020, about 8 years after I turned down the offer, I regretted in tears. As she gave up her last breath, I cried I wished I had listened to her, I wish I was a doctor. And I truly wish I can turn back the hand of time, I wish I can go back to that day.

This is 2021, what led to her death was slow moving, spanning more than 15 years. Some things could have been done and for those who have better medical advice, some things are done.

I first heard of her condition was when I was about rounding up my WAEC. My dad had returned from work worried. He called me and said that Dr. Akpan had told him something so disturbing about my mum, that she had an enlarged heart and it is not a good thing. While very young then, I could see that what he had heard was disturbing information. This was around 2005.

The heart is an elastic container. It works to continually pump out blood, squeezing it out on every beat, every second, minutes, hours of the day throughout the lifespan of the individual.

When it does not squeeze the blood out effectively, however, for any reason when it retains some of it or it leaks blood back into the heart, over time, the blood retained in it buildups, making it enlarged, slowly becoming bigger and bigger and like all elastics materials, when stretched too much and too wide, it becomes weak, eventually loses its elasticity, its ability to squeezed back.

The symptoms were there that her heart health was failing. I believe the doctors would know and should know that any one developing an enlarge heart (or any other cardiac related issue) needs urgent attention to address the root cause.

There were a number of reasons she would visit the hospital, most of them would be getting tire easily, not having the ability to walk longer distances, edema (swollen legs), arthritis, waist pains, those conditions that would typically be associated with a person that has gain considerable weight. Each time she would visit the doctor for any of these reasons, each time an xray is made, it would always come out with the diagnosis of enlarged heart.

If I were a doctor, I would immediately refer her to a cardiologist for further examination and test. There was enough time since it was discovered early. There was a serious need to identify the cause of this condition, and while it may cost a lot of money, at least, the patient should understand what is going on and know the options before her. There was enough time for this. More than 15 years.

There are a number of reasons anyone would develop an enlarged heart. It could be that the person was born with a bicuspid aorta valve (instead of tricuspid aorta valve). Here aorta valve that prevent the blood from dripping back into the heart is made of 2 flaps (Instead of 3 flaps. Such persons normally develops heart related issues earlier than those with 3 flaps). It could be that an individual has a leaky aorta valve or it could be that some part of the heart muscle is death or calcification of the heart valve causing stiffening of the valve among other reasons. In any of these cases, it causes the heart to retain blood. As it continues to retain more volume of blood, the heart becomes enlarge, getting bigger and bigger as the months, years go by.

Every time an enlarged heart pumps, it is ejecting less blood, thereby leading to less blood around the body and in particular, less blood going to the kidneys. Now the kidneys are very sensitive to the amount of blood they received and its immediate reaction when getting less blood is 'this person is dehydrated, lets absorbed some water in trying to restore the amount of blood in circulation'. Normally, the kidneys get rid of water and other waste from the body through urine.

So the kidneys will absorbed more water, they would 'restore' the amount of blood in circulation, at least that is what the kidneys think they are doing. But the problem was never a shortage of blood, the problem was that the heart was never pumping effectively and that was why they were less blood getting to the kidneys. So the situation is, there is more blood in the heart, the heart still cannot pump all extra blood out because it is still weak and therefore the kidneys continue to get less blood, then the kidneys retain more water and the vicious circle continues for years where less blood getting to the kidneys, the kidneys retains water, the heart has extra blood to deal with etc.

As the years pass by, the amount of blood in the heart gets more and more, the heart continue stretching, getting bigger and bigger. Initially, when the heart is stretched, it acts like a rubber band, returning together with more force. However, as the heart is stretched more and more, it losses it elasticity, becoming weak and flappy.

These vicious circles happened to her. It was slow moving, took more than 15 years. The signs were there, the swollen legs, the breathlessness when going long distances or up the stairs, the weight gain despite all effort to lose them, the shortness of breath during the last week of her life. Thinking back today, I now understand why despite all effort to lose weight, it was never going to yield any result because of the enlarge heart - kidney interactions. It was her kidneys that were retaining the fluids.

Then again, on each recommendations for X-rays and the diagnosis of the heart conditions, not even once has the doctors referred her to a cardiologist for further examinations to get to the root of this condition. The recommendations has always been, lose weight, exercise, go on diet, but none of these were ever going to work and none actually did. The underlying problem(s) that led to the enlarged heart were masked with medications that would make her urinates the excess fluids. While providing temporary relief, the root cause was there, slowing causing more and more damage until the day she lost consciousness.

I am looking back with regret, I could have understood these condition and the mechanism behind them, the symptoms were before me long enough. Thinking about the mechanism of an enlarged heart, the kidneys, the less blood circulation, I am wondering if the many recommendations to exercise was of any good. All the extra working involved in exercising would really add to quickening the enlarging of the heart. Probably a case could have been made for the huge cost that the examinations and test needed to get to the root of the enlarging would have incurred, but at least we would have had the option, we would have know what was happening right before our very eyes and could have done something about it. If the root cause had been identified and addressed say 5 or 7 years ago, she could have had maybe 15 to 20 more years.

During the last one week of sharing this oxygen with the rest of living humanity, during this time she slip in and out of consciousness, not much could have been done except for the management care. When she crashed, during the CPR and all effort to resuscitate her, nothing more could have been done. I cried in regret wishing I had listened and switched to medicine 8 years ago, not because I could have provided better care than the doctors who attended to her (aside from the ethical implications, because at that stage, what she needed was a brand new heart), no, but because I could have understood the symptoms that had been present for years and would have offered better medical advice.

I cried in regret knowing that had I attended medical school, were I doctor, I would have understood the implications of what was happening over the past 5 or more years. I could have understood the mechanism driving the unexplained weight gain, the swollen legs, the breathlessness etc. While these symptoms were all attributed to excess weight, excess weight was only a symptom, we were only fighting the symptoms not the cause of the symptoms. I could have understood that the main problem was the heart that was getting larger and larger thereby not working effectively and the associated problems it brought. All these I could have understood and known, I could have advocated for the root cause to be identified and address. I failed you mum. cry cry cry I am so sorry. I should have listened to you. It could made a big difference. cry cry

I understand that life does not give us the opportunity for a do-over. This is the decision that hurts and hunts

Thanks for reading...📖📖