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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Another Plague – Seriously, What is Next?!

Porch Picnic

We had around a 3 week break in the rainy season, which has now come back with a vengeance. It is cold for Kijabe. That means a fire every day to warm the house, space heaters in the bedrooms, and nights huddled around the fireplace in camping chairs to stay warm. I miss the warmer nights (we were still in sweatshirts) of our mini dry spell with dinners on the porch.

Nights eating dinner on the porch are the best!

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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Life is More Spiritual In Kenya

Scan through this latest notice and tell me you do not agree that life is viewed more spiritually here.Screen Shot 2020-05-16 at 5.52.09 PMScreen Shot 2020-05-16 at 5.52.23 PMScreen Shot 2020-05-16 at 5.52.39 PMScreen Shot 2020-05-16 at 5.53.03 PMScreen Shot 2020-05-16 at 5.53.22 PMScreen Shot 2020-05-16 at 5.53.40 PMScreen Shot 2020-05-16 at 5.53.50 PM6th Presidential Address on COVID-19 – 16th may, 2020

Flooding

I mentioned a few days ago about the rain. Here are some pictures from the flooded out bridge and abandoned train station. We took a pretty long hike (appx 8 miles round trip) to get up to the area of the mud slides. Wow! It was impressive, and I think with more rain we can expect more damage unfortunately.

 

Social Distance

It’s not so hard to social distance from these guys. Do you see the baby hanging from the second baboons belly?

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Keeping my distance! 😳

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Lots of Rain – The Plagues

No water into blood, but we have had innumerous cicadas,

 

locusts,

 

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nairobi flies,

 

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and now constant rain. I would not want to be on the train seeing this for the first time. It looks like an Indiana Jones movie! Reports are no one was injured.

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Shopping

The little Super Duka has just what we need . . . tortilla chips, Coca Cola, Frosted Flakes, and candy. All are part of a well balanced diet.

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Shopping for groceries at the Duka

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