Today I fly to Kenya! Getting back home did not go as smoothly as hoped, but at last it is happening. Wednesday I went for my COVID test to be cleared to fly, and it came back inconclusive. What!!! That same day I got my second dose of the Moderna vaccine. And so yesterday I was up early to try and get another COVID test, but was also noticing that I felt a bit feverish and chilled. I knew this could be a side affect of the vaccine . . . I have heard that even some people get chills to the point of shakes. However, since I had an inconclusive test the day before, I was imagining that at last I was possibly coming down with COVID the day before I was scheduled to fly to Kenya. I will add that despite the fact that I felt a bit funky, I could have pushed through it without concern if not for the inconclusive test and the possible delay of my flight making me imagine worse outcomes. So I went back to the lab to get my test, and they told me their internet was down. Uh oh! Time to scramble to find another testing sight. Luckily there is an ER that will do the test for $450!! dollars with results in a couple hours. I drove over there quickly, and got my test. Negative! So I went to bed early last night after taking some Nyquil, and I feel better this morning, if not perfect. However, no fever or chills. I am off to the airport in an hour or so for the long flight and travel to Kijabe! I am glad to be going home, and I am glad to see my family soon. It has been too long!
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!
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.
Nineteen years of living with Allison. Ten houses in four countries in 19 years. We are having fun! Happy Anniversary!
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.
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.
Next year we get to be diners instead of servers! I am looking forward to being on the other side.
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.
As I type the air is filled with the echos of the African church singing an all day celebration.
It was a bit of a rough day in regards to mood in our house yesterday. I have been reading a little bit about exercise and mood enhancement, and the correlation is pretty strong that exercise is good for mental health. This is especially true in anxiety and depression. I would say those are the most common struggles of many of us, and especially those of us living in a different culture. I tend to be more optimistic if I find time to exercise, and I envy those who find it easy to do. I do not always want to exercise, much less do I find the time to do it. And this is despite knowing the positive effects. So with everyone a bit down yesterday, I decided we were going on a walk. We would go to the caves and then up to the railroad tracks. A few short steep uphill sections followed by a meandering downhill walk. We noted some clouds in the sky, but it seemed like there was more sun than clouds. The old Boy Scout in me recommended we take some jackets. It was good that we did, because just as we reached the cave, the rain came. We decided we would cross-country home, bush-wacking, avoiding steep drop-offs, spraining wrists, and ruining clothing. But we made it. And you can decide for yourself from the picture whether it had a positive affect.
Will continues to be busy in the hospital. For the last 6 months he has been serving primarily on the obstetrics service with occasional shifts in the emergency department. Working in obstetrics means lots of nights on call with runs to the hospital for whatever emergency has recently arrived. It can be tiring, so pray that he will have the energy he needs for each day. A bigger part of Will’s job is Christian medical education. The hospital is full of young doctors, clinical officers, and nurses who come to Kijabe Mission Hospital for medical training. Each day Will is involved in teaching these young doctors through mentoring and training in the wards as well as in didactic medical lectures. The hope is that these doctors will go throughout Kenya and East Africa, practicing excellent medicine as well as sharing the good news of the gospel of Jesus Christ.