Thread by @DrSeunO

1/ "wow, it is great to be alive, how is everyone... Hope we all had a good day after we departed yesterday" justice tried welcoming everyone.
"hope you took sometime out to think about the mother's account of event. There were some questions, I wanted to ask, but for Prof"

2/ "not to waste so much time, we will get down into it immediately, today we shall listen to the account of events from the nurse, if time permits we will listen to the doctor too

3/ "once again, I wish to remind us that, it is not our duty to apportion blame, that is for the civil Court to do. Ours is to listen, highlight the factors and hope that our recommendations will help improve our healthcare system"

4/ "are we good to go?"
"Yes we are" Dr. Dalong said excitedly
"Yes I'm" Aljiha said with apprehension
"you don't sound alright" Prof asked Aljiha
"that's true, that is because, as much as we don't want to pass blame, it always fall at the feet of the nurses" she responded

5/ "that is due to the outlook that nurses generally give, an aloofness that can't be explained" Mrs. Adeloba interjected

6/ "I really do not want us to argue about who is at fault or not, it will create a bias, we need to have an open mind towards what these professionals are going to say, nurses, doctors alike" justice took over
"Shall we call the nurse in?"

7/ "Yes please" everyone else chorused
"Please call in the nurse" justice to bailiff

8/ A young lady, probably in her 30s walked in, athletic build, smartly dressed. She oozed every sign of professionalism.

9/ "my name is Justice Nnamdi Chukwuka and these are my distinguished colleagues on this panel" justice introduced everyone to her. She was paying close attention, not one word or action eluded her

10/ "could you state your name for the records please Miss or Mrs.?
It's Miss, Miss Adetoun Abubakar" she started.
"A registered nurse, 8 years of nursing experience spanning the wards and emergencies with a PALS certificate. I'm also a Christian" she concluded

11/ "scratch that last part" justice said to the clerk recording daily events
"unless, you want me to believe that your religious affiliation had an impact on how this young child was treated" justice said to the nurse.
"no it doesn't, I just thought I put it out there"

12/ "it is good to know, but of no importance to this issue, thank you" justice informed her
"on the 10th of March 2015, you were involved in the care of a 7 years old child"
"could you provide us with every detail you can remember, from the moment the child stepped in, to death"

13/ "it was past 8am, we had just taken handover from the night team, when I heard someone screaming help, help, please help my child"
"sorry to cut you short" Aljiha interrupted
"you said WE, how many are WE?" she asked with justice nodding his head to the question.

14/ "also, how many patient were handed over to you" she enquired
"We were 3 nurses, 47 patients were handed over. One of us, it was her first day in the emergency, so she also didn't know her way around" the nurse stated.

15/ " I ran up to her, collected the child from her, ran into the emergency while calling the doctor on duty"
"the doctor came in and...."
"how long did it take the doctor to respond to your call" Prof asked
"the mother said, it took about 7-8 mins for the doctor to get to you"

16/ "No sir, it probably took him 2 mins" she responded
"how come the mother claimed 7-8 mins then" Mrs. Adeloba countered
"I guess because when you looking for something and it is not been done, time goes so slowly." Adetoun responded

17/ "the idea that we nurses laze about is not new, we face it everyday, from everyone. People think that we are not giving our best just because we are walking when they want us to run, we are calm, when they expect us to be rattled. We face that everyday and it is sickening"

18/ "please continue Miss Adetoun, I can detect a note of indignation in your voice" justice said
"I'm sorry sir. I'm only defending myself and my profession"
"as you should rightly do, please continue" justice said.

19/ "the doctor came, I told him the O2 Sats was 83%, he asked I titrate oxygen on him upto 98%. He did a quick examination, put in a cannula, collected bloods for tests. He muttered something about ICU and also requested for X-ray, a chest X-ray.

20/ "the mother claimed that the doctor didn't pay attention to them, he didn't inform them of what was going on and how things would be done for her child" Mrs. Oluwakemi stated.

21/ "well, I cannot speak for the doctor, whether he did or didn't... He would have his reason. The child died in 2 hours of arrival, 2 hours in a Paed emergency is like 2 mins for we health workers, things happen so fast"

22/ "look, the child was doing poorly, I did nothing wrong, I did everything by the book" she blurted out
"Please continue, we are not here to apportion blame, just here for the events surrounding his death" justice calmed her down.

23/ "I listed out the other vitals to the doctor, he asked we start antibiotics on the child. The child was taken for X-ray and I didn't see them for another 50 mins or so. When they came back, there was no X-ray film with them"

24/ "the mother said, they were asked to come back in like 20mins for the films"
"did you go with them to the X-ray" Dr Dalong asked.
"no, there were 10 critically ill patients, I can't leave them unmonitored"
"when they came back, the antibiotics and fluid was started"

25/ "a couple of times, the mother called my attention that the fluid is too slow and I tried explaining to her that it is timed for her child, it must have been tampered with because when we tried resuscitating the child, I noticed the 1litre bag is empty"

26/ "how often were you taken vitals on the child" Aljiha asked
"as best as I can ma, I would say once every 2 hours. There are other children who required monitoring and medication, there was no way I was going to abdicate my duty on them"

27/ "so in your own opinion, you were understaffed" justice said
"I would say so sir."
"since you are claiming that you were understaffed, what will be the ideal staffing for you" Mrs. Oluwakemi asked in an accusing manner.
"sorry, who is she again?" Adetoun asked

28/ "she is Mrs. Oluwakemi Ajenifuja, a mother of 4. She is here to give a parental view, especially a mother's view to the matter. She is also an entrepreneur" justice responded.
"Ahhhh, it makes sense now" Adetoun said with a sigh

29/ "Madam, if you care to know, the WHO recommendation is 1 nurse to 8 patient as at 2016. I had 20 patients that very day, 7 of which were critically ill." she continued

30/ "critically ill patient or patient with likelihood of injury to themselves like dementia patients are suppose to have a 1:1 staffing" she finished

31/ "what will you define as critically ill" Dr Dalong asked
"to me critically ill is anyone with a MEW score of 5"
"what is a MEWS score?" justice asked
"MEW score is a Modified Early Warning Score. It is a tool that allows quick detection of deteriorating patients"

32/ It comprises of TPR, level of "consciousness, O2 Saturation. Added to those parameters can also be input and output. Based on each score gotten per every observation, it gives the actions to undertake"

33/ "if you used the Mews score or whatever you called it, why didn't you notice when this child was deteriorating, you didn't even know that the child is dead until the mother called your attention" Mrs Oluwakemi asked

34/ "I didn't use the Mews score" she responded.
"Whattttttt? Justice, Dr. Dalong and Mrs Adeloba screamed.
" don't crucify her, let her tell you why she didn't use it, go ahead my dear, TELL THEM" Aljiha encouraged.
"we don't use the Mews Score in Nigeria" she stated

35/ "it is a not a nationally acknowledge observation tool, only few hospital uses it and those are private hospital. we are still stuck in the olden age of using TPR (temperature, pulse rate and Respiratory rate). That is what I used, that is the national observation tool."

36/ "as I said, I did everything by the book" she sighed
"if you know of a better way, why didn't you implement it" Dr. Dalong asked
"how many times have people at the forefront of clinical practice, the nurses, doctors brought ideas to you Dr. Dalong,

37/ how many have you implemented as a hospital administrator, is it not I WILL SEE WHAT I CAN DO that you people in administration say" Aljiha countered.

38/ "in your opinion young lady, what will you say is/are the major factor towards the child death?" justice asked

39/ "in my opinion, the late presentation of the mother to the hospital is the biggest factor. Second to that, the doctor is another factor" Adetoun said.

40/ Prof flipped through his write up aggressively.
"there is nothing you said so far, that point towards negligence on the doctor part, so why the doctor?" justice asked.
"the child should have been in the ICU" she responded

41/ "the child was Mewsing at 7 and diagnosed of sepsis, he should be in the ICU, he needed real time monitoring" she concluded.
"if you felt the child needed ICU, why didn't you express your concerns to the doctor" Prof asked

42/ "talk to the doc, and let him scream at me, isn't that what you doctor do, you believe we know nothing, can't understand what is going on with patient. We did anatomy, physiology in school as well, maybe not as deep as your own, but enough to understand"

43/ "thank you for your time, it has been very elucidating to us lay people. Also thank you for your service to humanity. You may go now" justice said
"fellow panel members, there you have it, the nurses view" justice deeply sighed
"Aljiha I don't know how you guys cope"

44/ "it has been a long day, shall we continue tomorrow or the day after...."
"the day after" they all chorused
"I'm definitely going to implement MEWS score in my hospital, I don't care what the national policy is" Dr. Dalong said
Everyone laughed
"ó jẹ̀bi" Mrs Oluwakemi said.