The Moments Before

This is what it looks like in the middle of the night right before doing surgery on a woman with an ectopic pregnancy. This mother of three came to our hospital with severe lower abdominal pain, a very fast heart beat, and low blood pressure. When we examined her abdomen it was very tender in the lower pelvic region. We did a quick ultrasound confirming our suspicion that she had a ruptured ectopic pregnancy. This is a surgical emergency. I walked quickly to the operating rooms and woke up the surgical staff, but I could not find the anesthetist. It turns out he was trying to help revive a 28 week baby who had been born two days earlier. I found him because the pediatrician called as I was sitting the in the OR and asked me how a different, critical patient in the ICU was doing. This other patient was admitted for severe HELLP syndrome. This is basically a multi-organ failure during pregnancy resulting in anemia, liver failure, clotting failure, and in this patient’s case she had developed blood clots in her lungs. I said she was stable, asking why she would want to know. It turned out this unfortunate woman’s baby had died. My on call anesthesia tech had been helping try to resuscitate the baby. Ari (the pediatrician) wanted to assess how the mother was doing in the ICU before she let her know her baby had died. I ran up to ICU to check on her, and I watched as Ari in the most gentle manner shared the bad news of our sick patient’s baby’s death. I walked quickly back to the OR, scrubbed in and opened up the abdomen of our ectopic pregnancy patient. The pelvis overflowed with blood and clots, but with suction the uterus was seen and the large ectopic pregnancy (this is a pregnancy outside of the uterus) was seen in the area where the fallopian tube enters the uterus. We took care of the dead ectopically positioned pregnancy, started a transfusion for the mother, and then closed up. I went home only to be woken to the news that another patient had a severe perineal tear from her early morning delivery. Back to the hospital I rushed to sew up this bleeding tear in the operating room. Today I have a lighter load, doing lectures in the ICU. I am so glad, because it was a tiring night. Oh, and its my birthday! A great start to year number 49. Yes that means I am 48 years old today. I cannot believe it.

Sophomore Restaurant

At Rift Valley Academy there are projects for each class to build unity as well as to serve the RVA community. One night is called Sophomore Restaurant. All the sophomores and their sponsors (we are some of them) work to plan a menu, advertise, arrange baby-sitting, and then it all comes together in one day while we cook, serve, clean, and entertain our RVA diners. I think it is the funnest thing we have done with the sophomores, and it was fun to watch them all work together to help one another and serve the RVA staff. Allison once again took on cooking responsibilities, and I helped run a small cafe next door that served those who were not able to get tickets to the main event. It was definitely an all day project.

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The line outside the small cafe where I helped.

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Allison getting the Mediterranean dishes ready

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Lots of food

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Dessert

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The servers enjoying a bit of down time

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A certain server getting tired of his father following him around. David had the hardest room full of Juniors and Seniors.

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Enjoying the leftover mousse

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Happy RVA and Kijabe Hospital staff enjoying a nice meal

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My favorite chef and waiter

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Proud sponsors

Next year we get to be diners instead of servers! I am looking forward to being on the other side.

Chess at RVA

I appreciate the teachers and staff at RVA that encourage the kids in the normal things of life.  Peter looks hopeful in this picture as he takes on the highly regarded Mr. Tilly. A mountain of victory worth trying to summit.

Mortality on the Bike

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. 99d6eefe-314d-412a-bfd7-a69db2f2edd5

Hyenas in the hood?

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!
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Happy Easter

As I type the air is filled with the echos of the African church singing an all day celebration.

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Happy Easter! ¡Feliz Pascua!

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