I spent the last Saturday morning participating in the exams of our Family Medicine residents. They were given 20 minutes with different patients to demonstrate their ability to interview, examine, and diagnose a patient. Overall they did well. I drove to Nairobi in the afternoon to see Avengers with a bunch of high school boys. Almost two hours in each direction makes for a long day, and the movie had better be worth it.
It can hit you hard sometimes, especially on a bike. I have only been on my bike a few times since I returned to Kenya from our Christmas in the US. Each time I go home I gain a few pounds (maybe a lot of pounds). I cannot resist Mexican food and hamburgers. But usually when I get back I drop 10 pounds just because of the setting. I had accomplished the weight gain in the last trip, but for some reason the weight loss was not following our arrival to Kijabe. I did not want to ride my bike because it is so much harder to pull this weight up the long hills. If I could just lose a few, then the bike ride would be more fun. And so I kept delaying. But last weekend a friend sent out a text saying they were going to ride Awesome Sauce, probably my favorite ride in Kijabe. I could not resist the invitation. I joined them at the local dukas, and we headed up the first steep hill by the waterfall. I began in the front, but ended the climb at the rear. I quickly came to the front in the next two downhills, but then came the next very steep climb. My heart began to beat out of my chest, the sweat of my head turned icy, and the world became smaller and less stable. I couldn’t do it. I hopped off my bike to push up the hill as I soberly realized I was not going to be able to make the ride. I called ahead to my friend who was already out of sight and said I was turning back. David graciously accompanied me on a return trip with some great downhills, but with none of the excitement of Awesome Sauce. Getting older can be great in some ways, but physically it can hit hard. There is a lesson in here somewhere. It probably is that you should exercise regularly and watch your weight. 
It’s 2:08 on Easter Sunday and the beautiful African choruses of the church across the way are wafting in through our open windows. It’s like having our own Paul Simon Graceland concert. Only really African.
We had a nice bit of cloud coverage for our Easter school picnic, the first clouds it seems like we’ve seen for weeks. I read the other day that Kenya is experiencing its worst drought in 38 years. Here on the mountainside and near the valley it is not as bad, but many in northern and western Kenya are struggling to survive. Last year it was the longest rainy season in a several years and now this drought. Here in Kenya, they have the “short rains” in November and December and the “long rains” from April through June. The whole time the temperature is an average of 68 degrees or so. It is a wonderful place to live, if you’re looking for a place to minister. Or if you want to come visit, read here.
Last night something funny happened that I thought was worth blogging about. We have a hospital station Whatsapp group that reports happenings around here. Recently, a couple of people have reported a clan of hyenas wandering around the outskirts of our complex. (Our compound is not fenced off and so we have all sorts of things drifting through—ne’er do wells, baboons, wild dogs, and now, hyenas). Our dog Chardonnay was barking a different and more insistent bark than usual in the middle of the night. Usually we can tie her leash to the back gate and she will be quiet, but last night, no such luck. I went out to check on her and from inside the house I could hear this high-pitched dog yapping or laughing sound. It sounded like cats? No. Monkeys? No. Puppies? Maybe, but different. I opened the door and Chardy was pulling hard on her leash, barking her most vehement bark. Crazily, I considered, “Is the hyena pack barking back?” All the neighborhood dogs were going crazy. I pulled our guard dog into the house and told Will that I may have heard hyenas. He laughed and opened the window to listen. He was convinced that it was just a dog or two. Even if it was, isn’t it surreal that hyena laughing was even on the table? Just in case we forgot that we live in Africa!
As I type the air is filled with the echos of the African church singing an all day celebration.
I walked into the ICU and the nurses came to me to tell me how a patient in the far bed was a walking miracle. It turns out he had hurt his neck two weeks previously, yet had continued to walk around Nairobi for a few weeks before he finally showed up in our emergency department. By the time I met him he was flat in bed with two large screws in the side of his head holding his neck in traction. All he complained of was a little weakness on the right side of his body. He was lucky he wasn’t paralyzed! Everyone was telling him how he was a miracle.
Chai time with my friend Abigail left me something to ponder. She said,
“Here in Africa, we just live by the grace of God.”
Happy to be on the medicine service with learners from the US, Kenya, and Vietnam.
The best part of the job is working with residents, medical officer interns, clinical officer interns and other consultants in the hospital. I am feeling especially pleasant this week because I am working on the internal medicine service. Last week I was in the ICU which is definitely intense. There is a definite lightening of the load when one gets to move away from the care of the deathly ill patients. The worst of last week was a young mother who came in at the young age of 32 years. Four weeks ago she delivered a baby premature. Something happened at her delivery, and she ended up needing four units of blood in transfusion. This happened in a hospital a in a different district. She was discharged and slowly became weaker and weaker with more and more trouble breathing. She presented to our hospital, and she was found to have a very weak heart. This is called peripartum cardiomyopathy. Hers was so bad that she had developed multiple organ failure. Her kidneys, lungs, liver, and heart were all failing. On top of that she had a big blood clot in her heart as well as a problem with the ability to clot her bood. We admitted her and began the fight for her life. Initially she responded to our treatment, and I was hopeful that she would get better. However after 3 days she quit improving. On day 4 she began vomiting blood. I had the sinking feeling during morning rounds that although she had improved and was better than when I first met her, that there was nothing more I could do to improve her more. Unfortunately that afternoon her heart stopped during an investigation to determine why she was vomiting blood, and after about 4 hours of trying to rescue her she passed. It will not be easy to get over. This week my patients are less sick, and I find myself almost skipping through the hospital, enjoying the people I work with and enjoying the patients who are getting better.
cairesonmission 