A Weekend of OB Call

  1. Saturday morning begins with hospital rounds with the residents. We see every patient in the obstetric department and discuss how they are doing as well as future treatment plans.
  2. I go and see a private patient who had a cesarean section several days previously who needs to be discharged. This is a nice visit interrupted by a call from the labor room.
  3. I return to the labor room, and we decide that one of our patients needs an urgent cesarean section for signs of fetal distress on her monitoring as well as for the fact that she is not opening or dilating her cervix at the appropriate rate. I send the medical officer to do this cesarean section while I hang close in case he needs some help.
  4. I am called again to the labor room where another mother’s infant monitor shows prolonged and late drops in the infant’s heart rate which indicates probable infant distress. We decide to do an emergency cesarean section, which is in truth more urgent than the one that is going on currently. There is not an option for a second room, so I scrub into the first surgery so that it can finish faster so that we can proceed with this now more urgent operation. At the end I ask for staple so I can close the skin faster and we can more quickly have the room ready for the next surgery, but for some reason the surgical staff is reluctant to give them to me. They want us to close with a skin stitch which takes much longer. I argue then for a second room that we can start preparing the next surgery while the skin is closed on this first operation. They concede a second room, and I am so thankful! Every minute counts. We do this operation very fast! The baby is OK!
  5. As I walk out the door of the operating rooms and into the delivery rooms I am pleased to be a part of a nice vaginal twin delivery (or was this another day – it gets a little blurry!)
  6. I am glad to rest at home for a little bit, but I had to call Allison to come to the hospital with an umbrella because it started raining thunderously just as it was time to head home. Thank you, Allison!
  7. I am so lucky to be home to see the eruption of the flying termites.
  8. I run in for a emergency cesarean section for a woman with preeclampsia (severe, complicated high blood pressure during pregnancy) who is also 33 weeks pregnant. She was being induced to delivery to cure this severe illness (it is the only way to cure it, and if you do not manage it well you can have both maternal and infant death in the very worst case scenarios) and the baby is not tolerating the labor well. We rush her back for emergent surgery and the pediatric team is ready to help with the infants as needed! I finish just in time to . . .
  9. I run up the hill to the Junior High Band concert from the hospital, arriving just in time!
  10. I return to the hospital at 3 in the morning for twin delivery in which the second baby is in a breech (bottom first) presentation. Both babies looked great!
  11. I go home to rest again
  12. On Sunday morning I return for a woman in hemorrhagic shock (a type of low blood pressure from overwhelming blood loss) who delivered in an outlying hospital but then had a retained placenta which caused her to have massive vaginal bleeding after her delivery. She is stabilized in the ER where she receives 3 liters of intravenous fluid to recover her blood pressure, and we take her back quickly for emergency dilitation and curretage to remove whatever has been left in her uterus causing her to have this massive amount of bleeding.  During the procedure she begins to have signs of instability again, but stabilizes with more fluids and blood. A lot of retained parts of placenta are removed manually.
  13. I return to the labor ward just in time to help a mother at full term pregnancy with a prolonged pushing stage of labor. This has led to the infant again showing signs of distress. I cut my first episiotomy in years (fundamentally I am opposed to episiotomies as they can cause worse tearing of the vagina compared to if things are just left alone), and I place a vacuum to assist the delivery. The infant has a very tight cord around the neck that tears as it is reduced spraying blood everywhere. The baby is OK.
  14. I finally do Sunday morning rounds on the patients.
  15. I go home and realize Allison is sick and has been in bed all day. A nasty stomach bug is making the rounds through Rift Valley Academy and among the missionaries of the hospital. I had it last week. I find her some medicine and administer it.
  16. Because the nursery has filled up with sick babies, we have to transfer out a 29 week pregnancy whose amniotic fluid sack has ruptured. She is doing well, but if she delivers now her baby will not survive because we are out of incubators.
  17. I see another patient with vaginal bleeding and severe uterine pain two days after an elective repeat cesarean section and start her on antibiotics for presumed uterine post-operative infection.
  18. Thankfully, I sleep most of Sunday night with only a few phone call consultations.
  19. On Monday morning the boys and I head to Nairobi for teeth straightening appointments.
  20. During all of this there were normal deliveries going on in the background in which I did not have to be present, but I was aware of them. They all went well! Sadly there were also some routine miscarriages, but everyone else was stable. Overall I think it was a good weekend.
  21. Other things of note during my nights on call. Allison kicks me out of the bedroom because there are so many phone calls that you cannot sleep well. So I sleep on a mattress on the living room floor.

Termites

I had been at the hospital most of the day when Sarah came running in the house saying “There are millions of termites in the soccer field. You need to come see!” I went out not really expecting much when to my surprise I saw what looked like wiggly smoke coming out of a 10 foot by 10 foot section of the field. As I walked closer lots of termites were crawling out of newly formed termite holes, and then taking off into the cloudy sky. I have never seen anything like it, and the video above does not do the experience justice. It was incredible. These are the same termites that many of the people eat after frying in a skillet, and if you are truly African you eat them raw from the air as Annie’s friend did last week. We always have to be careful with the cracks in our doors in windows because masses of termites try and crawl in toward the light in these first rainy days of the rainy season. As the smoke of termites finally cleared and dissipated, the girls proceeded to run around the field and slide in the mud. The messier the better!

Rainy season

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Third Culture Kids

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Simply having a wonderful birthday time

I’m taking a break from watching the monkeys play on the trees outside our kitchen window to write a bit about our crazy kids. This week we watched Coco as a family. The Spanish, the Spanglish, the painted concrete walls and big metal gates, the music, the way even the grandmother was drawn, with her apron and her tough square body type, made us all feel nostalgic for Peru, nostalgic for speaking Spanish and for our friends and our life in South America. Sarah reported the next morning that she had lain in bed “feeling very sad about missing Peru” afterward. Annie said watching the movie “made her feel like home.” We bought the soundtrack and sang along loudly in Spanish. A part of our hearts are with Latinos, and it made me remember again how important that has been and will be in our kids’ development.

Speaking of part of kids’ development, I’m teaching A Tale of Two Cities now, and as we discuss corrupt governments, wealthy people who don’t care, poverty, oppression, and worrying about providing food for your malnourished children, I see that most of my students understand. They have seen it firsthand. My students are, for the most part, grateful on a level that first world students will not experience. In a similar vein, Sarah had her birthday party last weekend and we played games with water, had chocolate cake and popcorn, and played some music for musical chairs. Her presents included a candy bar and a used stuffed animal. Every party participant expressed many thanks and enthusiasm for the simplest pleasures.

Annie’s birthday party, delayed a week because of Dad’s call schedule, was Friday night. Her friends came over to have pizza and outside games, but the rainy season may have arrived on March 1st, and it was raining like crazy. Annie and I went to the school gate to pick up her friends. On the way down, we saw many fluttering insects—I have heard them called flying termites—think dull brown, overgrown dragonflies. One girl squealed, “Ooh! The termites are here!” and squatted down to pick one up. Soon all six were holding a wriggling bug by the wings, watching it squirm. I smiled to myself, thinking “Only a group of missionary girls would react this way.” Then, one of the girls ate one. O.K. There you go. Wow. We got home and turned on some music while I finished preparing the pizza toppings. Every girl was dancing and singing unashamedly to Toby Mac. The third culture kid experience combined with a Christian family culture makes for a pretty awesome group of kids. We love getting to spend time with this unique group.

David’s Birthday

I am two days late with this post, but Saturday was David’s birthday. We celebrated with just family that day, because Sunday is when the party got going. I took a bunch of teenage red-blooded males to do paintball wars about 45 minutes from our house. The enthusiasm was contagious, the bruises were genuine, and the bravery may have been a little lacking. No one likes a paintball sting!

David is a great kid! He is very aware of injustice, he has an international viewpoint, and he is a good friend to people from many different cultures. He continues to try and do his best in the different circumstances in which he finds himself. It is easy to be proud of David! Scroll through the pictures below for some epic paintball shots! 😉

Birthday paintball wars!

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Peter Likes to Make Swords

Peter spent last Saturday making a sword all day long. He left the house in the morning and headed to the local duka (Swahili for store) to buy a long piece of steel. Then he went up to Mr. Manning’s house which is actually the 8th grade dorm to use his metal working tools. He spent the rest of the morning until lunch, cutting, sharpening, and refining his blade. Then after lunch he went back in the afternoon and continued to work on the hilt as well as welding on the guard. He has already spent quite a bit of time making throwing knives at Mr.Manning’s dorm. In the process he has learned well how to use several power tools, and he basically does most of the work unsupervised. Sometimes Mr. Manning will help with a more complicated project, such as fashioning the hilt. Peter said it is almost more fun to make the sword than it is to have it when it is done. This is one of the blessings of living in Kenya and especially near Rift Valley Academy. The kids have the freedom to pursue their interests, and they have men and women who want to help them. God is good to us with the community he has given us.

Swordsmith

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