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.
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.
I am still working in obstetrics. I did not expect it to be such a big part of my job when I moved to Kijabe. I have a love-hate relationship with delivering babies. When it is going well, it is fun and joyful. When it goes bad, it is probably the worst thing in medicine. And then there are times when things threaten to go bad, but because we are there as physicians and healthcare workers things go well. Of course, that is very satisfying. Probably the best part is holding babies after they are delivered. I should take advantage of the opportunity more often. I pray all the time when things get a little scary in the hospital. I trust God to help me make timely and wise decisions. And then I use the knowledge and experience that he has given me to do the very best I can. God is good, and I have learned a lot.