Two Encounters with Poison: Becoming a Doctor in Nigeria
“A smell of burning flesh fills the theatre. I was expecting the smell of blood—its rich, metallic, almost bitter-tasting organic scent.”
She wafts into the wooden-floored classroom, sure-footed and statuesque, taking her place at the front, between the ranked desks of our class of eleven-year-olds and the blackboard. We heard her heels clacking on the concrete corridor leading to our classroom before she arrived. We smelled her intensely rich, fruity perfume before we saw her. I know the scent: Poison by Christian Dior. I’ve seen the curved, bulbous, purple and gold bottle with a crystalline cap sitting on my glamorous aunt’s dressing table in the bedroom she shares with her husband, my uncle. He’s really my dad’s cousin, but as they are my guardians in this, my first year at boarding school, it’s easier to tell people that they are my uncle and aunt.
Mrs. Amobi strides back and forth in front of the blackboard, elegant in her shoulder-padded suit, the perfect scarlet ovals of her nails sweeping through the air as she gesticulates. Each movement seems to release a gust of Poison’d air that floats through the rapidly warming classroom. She asks us to open our General Science textbooks, lying neatly on our desks before us. The textbook that we use, the same one used by first-year secondary pupils across Nigeria, is actually a textbook of Integrated Science, but for some reason at our school, the subject is still called General Science. It is probably something to do with tradition. Ours is one of the oldest schools in the country—the first set up by the colonial government—and a lot of emphasis is laid on doing things the King’s College way.
She is teaching us about cells, about how in the human body they aggregate to form tissues, which themselves form organs, and how organs form systems and systems, the body. She pauses from time to time to scribble in chalk on the blackboard, but the alchemy of her strong perfume and the tropical afternoon sun seems to induce in many of us a stultifying lethargy.
It is with something of a sense of relief that we watch her clap her hands, releasing a flurry of chalk, announcing that the lesson is over, promising to see us again next week.
Hers is the last lesson period before break time, and as she leaves, we pour out into the corridors, heading for the tuck shop to buy biscuits and soft drinks at the kiosk or just to loiter, for those of us whose pocket money does not run to such luxuries.
After break, we settle back into class and one of the older boys, a prefect, four years ahead of us, walks in on an errand. He sniffs the air exaggeratedly and then says, “Ah, I see you have had a General Science lesson today.”
Years later I encounter the scent of Poison again.
It is the beginning of our surgical postings—we are fourth-year medical students, excited at our first time in the operating theatre. We step on to the walkway, sloped to make it easier for trolleys to move patients freely in and out of the theatre. Our scrubs are nestled inside the cheap plastic shopping bags that we clutch as we ascend to the massive swing doors at the theatre’s entrance. Also inside these bags are the rubber slippers, squeaky in their newness, that we have been asked to buy, the only footwear we are allowed to wear within the sterile theatre.
We chatter nervously in our small group to mask our anxiety. There are maybe six or seven of us. One of us pushes the doors open, leading into a corridor with several rooms leading off it. Ahead, we can see the thick red line painted on the floor, demarcating the sterile areas of the theatre from the non-sterile. Later, as a newly qualified doctor, during my housemanship year, I will come to know that barrier well. I will cross it frequently, sent as an emissary of the team in the theatre, to chase up blood results, collect blood from the blood bank, check up on patients back on the wards, or to talk to anxious relatives standing, sitting, or lying just outside the theatre, waiting for news.
We walk down the corridor and follow the signs for the students’ changing room; there is only one, and it is for men. (Our female classmates have to change in the nurses’ room across the corridor from us.) We enter the room filled with men, some still in their outdoor clothes, their shirts buttoned, their ties knotted. Others are unbuttoning their shirts, unknotting their ties, carefully hanging them up. Some have their torsos or legs bared, exposing singlets and underwear of varying shades of white, varying degrees of wear, as they pull on their scrubs. The steel lockers lining the walls, cramming us in, frame the scene.
Apart from fellow medical students, the room is also filled with student nurse anaesthetists who come from all over the country. Our teaching hospital is one of the few that run a special program for nurse anaesthesiologists, needed to assuage the national shortage of trained anaesthesiologists. The room is thick with the scent of male sweat; the cheap cologne that many of us wear does not mask it.
There are a couple of tattered armchairs in a corner—a student anaesthetist sprawls in one, his head thrown back, mouth open, catching a quick nap. On another, two medical students sit, their heads bent over a textbook, doing some quick revision before heading to the theatre, trying to prepare themselves for the barrage of questions that will come their way. The surgeons often seek to relieve the tedium of their work, it seems, by barking questions at the medical students and residents.
We squeeze our way to the center of the changing room with sideways movements of our shoulders and elbows. I make out a spot in front of a locker, hang my scrubs on the corner of the door, and take off my outdoor clothes, standing for a moment, shy in my boxer shorts, glad that there are no holes in them. I pull on the trousers—gathering together the ends of cloth dangling in front and tying them firmly in a knot—around my waist. Then I pull the tunic-like top over my head.
It is the first time that we wear scrubs, and our heads swell with giddy pride at this milestone. Dressed in this universal uniform, we feel like real doctors-to-be, our debut in theatre a thrilling change from the crowded lectures and hours hunched over textbooks in class. It does not matter that we are here simply to observe, that we will not actually be touching any of the instruments or doing any of the procedures. What matters is that we are here, in our green scrubs, as part of the team, indistinguishable to an untrained eye from the real surgeons and the rest of the theatre staff.
All changed, we walk out of the changing room, turn left and, just before the double red line, stop at the matrons’ office to collect the paper head coverings and masks that we will be obliged to wear inside the operating theatres, completing our uniform.
The door to the matrons’ office is ajar and we see the duty matron sitting at a desk, her hair covered in what looks like a pale blue-green paper shower cap, from which a few strands of grey hair escape at the front. The cap matches the pale blue-green gown that she wears, similar to but distinct from, the deeper green of our scrubs. She exudes an air of competent, efficient weariness, with her expertly red-lipsticked mouth, her gold-rimmed spectacles, the gold hoops in her ears. It is as if running the theatre is something that she has learnt to do, does well, but is faintly bored by.
She lifts up a box of paper masks, blue and white, another box of surgical caps, and meets us at the door. As she hands them out, she says: “Medical students, this is the last time I am going to give these out. Take good care of them, don’t come back next week and ask me for new ones.”
A smell of burning flesh fills the theatre.
I was expecting the smell of blood—its rich, metallic, almost bitter-tasting organic scent. I wasn’t surprised by the lemony smell of the pink chlorhexidine antiseptic fluid that the surgeons have used to scrub their hands and arms, grasping the short nail brushes firmly as they scrub viciously at their skin. Using the same antiseptic, they cleanse the skin at the incision site, using white cotton swab after white cotton swab, like my aunt cleansing her face before applying make-up. They continue until the swabs are no longer dirtied by the patient’s skin. Then I watch as the registrar wields yet another white cotton swab, dunked in a brownish yellow fluid, clamped firmly in the jaws of a pair of forceps, painting the site for the incision; I am not surprised by the clean paper-like smell of the iodine.
But burning flesh?
I’ve been prepared for what to expect in theatre through my great hunger for books, the many novels about hospitals and surgeons that I have read. From the acutely realistic The Surgeon, set in an American hospital in the 1950s, to Erich Segal’s Doctors, set in Harvard Medical School in the 1960s, and the engaging Dr. Amadi’s Postings, recounting the adventures of a young Nigerian doctor in the 1960s, I have devoured them all. And so I think that I am reasonably familiar with what goes on in theatre, and what to expect. There, as in the novels, is the green-gowned surgeon and his assistant; there, the scrub nurse with her tray of instruments laid neatly before her, slapping the right instrument into the hand of the surgeon as he works. The expected smells of blood and antiseptic suffuse the theatre, together with the starchy smell of freshly laundered cotton drapes and surgical gowns.
But after the surgeon has made his incision with a scalpel, his assistant’s hands darting forward with a white swab to dab and staunch the blood oozing from the wound, he utters a phrase that I have not expected to hear. “Diathermy at 8,” he barks, his voice muffled through the mask that covers his lower face. The scrub nurse hands him a wand with a tapering point, connected to an electric wire. He applies the tip of the wand to the edges of the wound, red with oozing blood, stark against the yellow of the fat globules exposed just under the skin. A smell of burning flesh, not unlike the smell that comes from the mai suya, the grilled meat hawker’s stall, fills the theatre.
I am for a few minutes overwhelmed, so strong is the smell, and I step out into the corridor to compose myself.
I am leaning against a trolley, just outside the operating theatre, probably the one that conveyed our patient from the ward, when I sense again that rich, fruity scent. I look up; it is one of the student nurses. She is walking briskly, a set of case notes clasped to her breast, waves of Poison wafting from her. I am briefly transported, away from the theatre, back to the classroom, listening to Mrs. Amobi talk about cells and tissues and organs.
Ike Anya trained and worked as a medical doctor in Nigeria, before undertaking postgraduate specialist training in public health medicine in the UK. His writing has appeared in Eclectica and he recently completed the MA in Biography and Creative Non- Fiction at the University of East Anglia. "People Don’t Get Depressed in Nigeria," an early excerpt from his memoir-in-progress about becoming a doctor in Nigeria, was published in Granta in 2012. He is co-founder of the Abuja Literary Society, and coedited The Weaverbird Collection of New Nigerian Fiction in 2008. Twitter: @ikeanya