Fillers A memorable conversation

Did my wife elope with someone else?

BMJ 2004; 328 doi: (Published 01 January 2004) Cite this as: BMJ 2004;328:29
  1. Wayengera Misaki (wmisaki{at}, editor in chief
  1. Makerere Medical Journal (MMJ), Makerere Medical School, Kampala, Uganda

    Mienwa, leader of the senior clerks clerking obstetrics and gynaecology, after watching Senegal triumph over France in their group opening match of the 2002 World Cup, reluctantly strolls back to the ward in an exuberant mood he just cannot conceal. Being the extrovert that he is makes it even more plain to all the staff on the ward.

    “You cut [dodged] the ward round this morning just because you were watching football,” comments the SIC (sister in charge), “You men are just too obsessed with that game.”

    “Oh yeah, I just couldn't miss seeing Diouf do his thing in this opener,” retorts Mienwa, lifting his leg as though he were hitting a ball. “Who is the SHO on call tonight?”

    “It's Dr Wange; he is in the evacuation room,” answers sister.

    In the evacuation room Mienwa finds Dr Wange alone, gazing fixedly through the window. “Good evening, Dr Wange. You seem unwell, mind sharing the problem?”

    “Good evening, World Cup fanatic, it's good you've come by,” replies (sarcastically) Dr Wange, reluctantly turning his gaze to Mienwa. “Let's say I have this problem that I have been contemplating to share with someone, and I had just ‘tossed the die'in my mind that whosoever comes in here first will be that special counsellor to listen. Will you please take me up as your client?”

    Still excited, Mienwa exaggerates the context, “You mean I am that lucky counsellor? OK, I am glad to exchange roles once more today. First, it was medical student for World Cup fanatic this morning, and now it's junior clerk for psychiatrist. So ‘shoot,’ what is the problem, client?”

    “It's my wife, Mienwa, she has developed the typical triad of pre-eclampsia (hypertension, oedema, and proteinuria) suddenly in this, her fifth, pregnancy. Her previous obstetric history was normal, she is not a known hypertensive, and at least the ultrasound sonography taken at her last ANC visit revealed a normal pregnancy: you know what I mean—no multiple pregnancy or monster [hydatidiform mole] in utero.

    “My neighbour whom I ‘toss with the bottle’ at the pub, hinted to me about someone ‘eating from the same bowl’ with me, but I shrugged it off. Now here I am, helplessly faced with this HELLP syndrome. Can you solve my puzzle, Mr Psychiatrist?”

    “Damn, you got just the right professional to consult,” Mienwa replies, “I deduce from your story that you are faced with what ‘we’ often label as the ‘wise man's blues.’ Being knowledgable of the possible causes of your problem without clear cut proof to support your high index of suspicion for any particular one, you've probably been left nowhere else in this case but in the ‘Othello syndrome.’”

    “What a hell on earth is that, Mr Psychiatrist?”

    “Relax, client. All I mean is this: here you are, scared (or I may say jealous) of the possibility that your wife cheated on you, and that it's possible you are not responsible for this last pregnancy—all because you know that change of sexual partners is one of the implicated predisposing factors to pre-eclampsia in later pregnancies in women without such a history during their first pregnancy. Mrs Naka [the consultant] told us a story of how the Baganda [a dominant Bantu tribe] men of long ago would detect pregnancies they were not responsible for when their wives developed eclampsia in later pregnancies. I reckon you've just receded back in time.

    “Your high index of suspicion is sound, but selectively (your wife!) not scientifically reliable. I suggest you take her as the index case in a study you should initiate to test your suspicions. How about that?”

    “Excellent. You've just given me an insight into a topic for my dissertation,” says Dr Wange, while tapping on Mienwa's back. “Let's go to work. I think we have a hydatidiform mole to curette.”

    This is a fictional account reconstructed from a conversation we held on a ward round with a senior house officer and consultant during my obstetrics and gynaecology clinical rotations. Its object is to convey humour and pathos. No real person is referred to.

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