A Day in the Life . . . Friday in the ICU

I walked the long way into work (its not long really) because we have closed off all but two entrances into the hospital so that all can be temperature screened before entering. It is nice to enjoy the very brisk morning air, watch the monkeys, and listen to a podcast.

8:30 AM     Time for the weekly audit of mortalities and close calls on the internal medicine service. This week a lot of time was spent discussing the COVID ward and some ICU complications from the past week. At the end I got a nice despedida with a coffee mug that I had been hoping to get with the Kijabe Hospital logo.

10:00 AM     Rounds in the ICU. In the last 2 days we have added 8 new patients. Yesterday was worse when I had six new patients in the span of just a few hours. Today it is just two new patients. Severe hyponatremia, a patient with a adrenalectomy in whom we have to closely watch the potassium and blood pressure, a myasthenia gravis with mucus plugging causing one lung to not function well (she got a tracheostomy yesterday), a traffic accident with a broken hip and ribs, status epilepticus, sepsis in a patient with esophageal cancer, another who has had her right shoulder and arm removed for cancer complications, severe diabetic ketoacidosis and sepsis . . . the list goes on!

12:30     Time to do some record keeping of the patient for the last week so that we have good records of what they presented with, how they did, how long they were in the hospital. We do this to see trends in our care and illness and improve quality over time.

2:00     No lunch today. It made me wish I had eaten breakfast. The coffee from the morning was serving me well. Time to teach EKG reading to my trainees. One is an orthopedic resident. The other is a medical intern (1st year out of medical school). They have been with me all week on the ICU service.

3:30    Afternoon rounds on all the patients from the morning to see how they have progressed. Everyone seems to be ok, although many are still sick. Several are well enough to leave the ICU.

4:15     I get a call from one of my ECCCOs (ICU clinical officer) stating there is a problem in one of the HDU (like an ICU but without a ventilator). One of the surgical patients we have been rounding on who had major spinal surgery now has a heart rate of 200! This is new to us. An EKG is ordered. She is stable, and I take the moment of getting the EKG to take Dr. Steve on rounds of all the patient in the ICU service. Steve is on call tonight, and I confess I am relieved that he can take the lead on dealing with the tachycardic patient. Is it a sinus tachycardia or atrial fibrillation with rapid ventricular response. Hopefully the EKG give him some clues.

5:00    Steve is in charge. I leave notes on all the patients for the weekend coverage doctor, and head home to start packing for my flight on Saturday. A pretty full day for my final ICU day for awhile.

Being at Kijabe has to be one of the best jobs in the world!

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Our Internal Medicine team after morning audit.

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Passing Head of Department duties happily off to Dr. Tony

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Friday Morning Internal Medicine Audit

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Teaching EKGs

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Par Three at RVA

Last week there was a golf tournament at RVA. One of the staff at the kid’s school put together a small par three course around the upper field. So now this spring instead of rugby cheers on the paddock, you hear cries of “Fore!” Small groups moved around the course, with a closest to the pin contest and free cokes for each hole in one. The low scorer won two free pizzas from the local Pizza Inn. Its a tiny course, but it is a lot of fun for a quick nine holes. Tennis courts are water hazards. Soccer goals are tall trees in the fairway. The wind blows across the pitch toward Mt. Longonot in the valley. You are considered in the hole when your ball is within a club length of the flag. There are no greens and the fairways are deep as rough. David and Peter have picked up clubs for almost the first time, and progress is being made by all of us in our nine iron game.

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RVA Par 3

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Hash-up Mash-up

During quarantine, I’ve noticed that everyone’s new favorite hobbies are cooking and baking. I say amen to that. What’s better than a hobby you can EAT? I’ve been thinking I should revive my occasional recipe sharing on the blog.

To that end, here’s a super simple yet satisfying meal for those celebrated “breakfast for dinner” nights. I suppose you could make it before noon, but that’s your call.

Hash-up Mash-up

Ingredients:

enough potatoes to grate about 4-5 cups; 5 or 6 big potatoes, 12 or so medium red potatoes

10 eggs

cooking oil

salt and pepper

  • optional: bacon, Freddy’s Fry Seasoning

Directions:

  1. Boil the whole potatoes in water to cover for 15 minutes or until fork-tender. Set potatoes aside to cool a bit. (If you are in a place where you can get a bag of frozen hash browns, you can skip the potato part of the recipe. This is a missionary blog, so this is how we make it.)
  2. If you are using bacon, start by frying bacon in your biggest, most non-stick sauté pan.
  3. Grate the cooled potatoes on the biggest holes of your box grater.
  4. Leave the bacon grease in the pan or if you didn’t start with bacon, put 2-3 tablespoons cooking oil in the pan.
  5. Put the grated potato in the oil or grease and spread it out to the edges for a layer of potatoes.
  6. Here’s the part that requires patience– let it sit at least 5 minutes or more without moving it (more time if you started with frozen hash browns) When you lift up one edge and it looks good and golden brown underneath, flip pieces of hash browns with your spatula. Now let the other side brown. You may need to drizzle more oil on so that you get a good fry. While the potatoes are frying, generously sprinkle with salt and pepper. *On a whim, I bought a jar of Freddy’s Fry seasoning and brought it to Africa. If you live on the I-35 corridor and can get some, we recommend. If not, you can make it. Good stuff to add at this stage.
  7. With patience, you’ll get a pan of beautiful golden brown hash browns. While you are waiting, crack 10 eggs into a bowl.
  8. Now you will add the protein. If you have a thick layer of hash browns, you can make little divots in the hash browns to receive eggs. Pour the eggs over the hash browns, evenly distribute the yolks if needed, and cover with a tight lid. The steam from the potatoes will make sort-of basted eggs and the bottom will get nice and crispy.
  9. Serve a wedge of Hash-up Mash-up with ketchup, sriracha sauce, hot sauce, and/or Ranch dressing, plus bacon, fruit salad, waffles, etc. ¡Bon appétit! 

 

Sarah’s Pet

She won’t touch a grasshopper, but she loves a slug!

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Sarah’s new pet

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April 13 and COVID 19

I am back into the hospital today after the weekend off for Easter. So far no cases in Kijabe Hospital which makes us wonder what may be going on in Kenya and in Africa in general. We keep saying we are a week or two away, and then nothing. I am glad, and I confess each day makes me more optimistic that we will miss the worst of it. There are multiple reasons that could play a role in what appears to be a less significant outbreak. We live in a tropical zone with lots of direct sunlight. Most of the population has received a BCG anti-tuberculosis inoculation which could impart some partial immunity. A higher percent of our population is on anti-retroviral medication (the treatment for HIV). Maybe there is a genetic predisposition against the virus. Also we have quite a few corona-type viruses that circulate through our community that could be imparting a partial immunity. Possibly an early move to partial quarantine slowed the infection rate. In the end it is confusing, because none of the listed reasons above seem to explain what appears to be less cases here. So maybe we are just behind, and it will come on strong in the next month. In the end I am thankful that it is not bad, and I pray that God will have mercy on the people of Africa, especially the poor.

Happy Day after Easter from our family!

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How are you?

How are you, friends, during this topsy turvy time? It is hard to imagine the places we love emptied of worshippers, groceries, patrons, and pedestrians. We pray that you have peace, confidence, and toilet paper.

A few of you have asked how we are. I am sorry that we have been such sporadic communicators on the blog. I confess that I forget to be grateful for all the people around the world who care about us and pray for us. I’m afraid I focus on the people and projects here in Kenya and I neglect to look around and give thanks for those who allow us to be here.

So, into the third paragraph, how are we? We are fine. Kenya is behind the curve, as it were, in the development of the coronavirus. We have a few cases, brought in by travelers, but it is not spread through community transmission yet. We don’t have a documented case in our hospital, but Will and the Kijabe Hospital staff are gearing up for the influx of patients. They are surprised at the relative calm thus far. Will has been watching lots of medical videos about treating COVID-19 and how to best use the available ventilators in the hospital.

Rift Valley Academy decided to end school two and a half weeks before our scheduled term break. There was a Herculean effort to get almost 300 dorm kids scheduled on planes, trains, and buses out of Kenya and to the countries where their families live with only 4 days’ notice. Amazing stories trickled in over the weekend of students’ flights being received only minutes before the border was closed, of students who were going to be quarantined in the airport, but some kindly official released them to their friends’ father, a medical missionary, and of arduous 40-hour bus rides that ended in successful border crossings.

The early closure meant that all junior and senior educational trips (called “Interims”) were cancelled, including mine to Spain. David was scheduled to go to Zanzibar, Tanzania. That was a tough blow to all the upperclassmen. The sudden closure meant the seniors had to say their goodbyes in a day or two, not knowing whether they would return from their country nor when. My heart goes out to these seniors whose lives are so full of change and transition anyway and then this unique kink in plans was added. One crazy story from a student whose parents have served in mostly closed countries is that she said that until now, RVA was the only place she had lived from which she had not been evacuated.

Right now, we teachers are knee-deep in tech training so that we can commence online classes with a hope to see our students face-to-face when God allows.

We had been looking forward to returning to the Christian Medical and Dental Association’s medical mission conference in Greece in April. It was a great place to connect with our fellow Christian Health Service Corps missionaries serving in East Africa, plus there was great food and it was fun to be in Europe. Of course, that is cancelled, much to the chagrin of the family.

For now, though, we are thankful for the beautiful weather, the community of fellow missionaries, the (so-far) stocked grocery stores in Nairobi, the people who have helped all of us make big decisions, the hand of God sustaining us.

Many of you are doing BSF, as am I (my class was already a video chat!), so I will leave you with a quote from this weeks’ lesson: “Therefore, my dear brothers and sisters, stand firm. Let nothing move you. Always give yourselves fully to the work of the Lord, because you know that your labor in the Lord is not in vain.” I Corinthians 15:58

Photos of recent shenanigans:

Living Life with Allison is Awesome

Nineteen years of living with Allison. Ten houses in four countries in 19 years. We are having fun! Happy Anniversary!

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Chillin’ with A in Nairobi

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My sweet Valentine!

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Awesome selfies by Will and Allison

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I brought a friend with me today!

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True love in Cuzco

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Feeling the love at 14,000 feet!

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Big kiss under big mistletoe!

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Hoodies and a hug keep a couple warm!

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Come away with me my love.

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Livin' the life in Cura-town!

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What’s New

We are looking forward to the Christmas season! Thanksgiving will be a quick after work and school dinner with some of our friends here in Kijabe, then after a half day of school on Friday, Christmas break will begin. (For those who do not know our school runs on a trimester system with three month long breaks each year.) Some much deserved rest for Allison and the kids will be enjoyed afterward. Allison continues to work hard as Head of the Department for International Languages. It is a role with many responsibilities, some enjoyable, others not as much. She and her students inaugurated a Spanish Club which started the year with a Spanish Karaoke party that went off with moderate success. I wanted to get up and sing, but I didn’t want to be that Dad at the party, so I held back. I am now working as Head of Department for Internal Medicine at AIC Kijabe Mission Hospital. I continue to take call in the Obstetrics department, as well as in the ICU and the Internal Medicine wards. I enjoy the work a lot, and I hope that I can grow into the role of HOD. Administration has not always been my strong suit, but I feel privileged to serve, and I know it was a position that needed to be filled. The kids are doing well, and Allison and I are facing the the reality that David will be gone in just around 18 months! He is busy at school with Model United Nations, running a pizza delivery business, creating his vlog, and working at the Teddy’s, the student snack shop. Peter is doing well in his freshman year participating in choir, jazz band, and band as a trumpet player. He also quite fascinated with the guitar. Annie is in junior high band playing trombone. She loves drama and is excited to be a part of the field hockey team. Sarah is thriving as a sixth grader, the top of Titchie (elementary school). She plays piano and is venturing into saxophone. All of them are busy. As a family we try and get into Nairobi for good food when we can, and about once a month we try and head the other direction to Lake Naivasha to escape the hospital and relax in the best part of what Kenya has to offer (besides the awesome people of course), its natural beauty and wildlife. Thanks for thinking of us and praying for us. We trust God for the energy to live cross culturally and to do the good work he has given us to do.